Job Description

The Insurance Verification Representative is responsible for verifying insurance coverage and benefits for scheduled procedures and services. This role ensures accuracy in patient records and assists in obtaining prior authorizations, if needed, to facilitate timely reimbursement. The Insurance Verification Representative works closely with clinical and administrative teams to provide a seamless patient experience.

Essential Functions

• Verifies patient insurance information, including eligibility, benefits, and coverage limitations.
• Reviews scheduled services and procedures to determine any necessary pre-certifications or authorizations.
• Coordinates with insurance providers to obtain required authorizations and verifies prior approvals.
• Communicates insurance requirements and benefit information to patients and answers any questions related to coverage.
• Accurately enters and updates insurance information in the patient’s medical record and billing systems.
• Identifies and resolves any insurance-related discrepancies or issues, working with other departments as necessary.
• Assists with resolving denied authorizations and facilitates appeals as required.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• 0-2 years of experience in insurance verification, billing, or a related role in a healthcare setting required

Knowledge, Skills and Abilities

• Basic knowledge of insurance terminology, eligibility verification, and authorization processes.
• Strong attention to detail and accuracy in data entry and documentation.
• Effective communication and interpersonal skills for interacting with patients, staff, and insurance companies.
• Ability to manage time effectively and work in a fast-paced environment.
• Proficient in basic computer skills and comfortable navigating healthcare billing or insurance software.