Eligibility & Benefits Verification Specialist

CredSpun LLC; United States; Remote; USD 25,000 - 39,000; Full time

Job summary

CredSpun LLC is seeking a remote Insurance Eligibility & Benefits Verification Specialist to confirm patients’ coverage before visits. You will verify plans, benefits, and eligibility so the front desk collects the right information and claims don’t get denied later.

You will work with payer portals, Availity and real-time eligibility tools (270/271), determine if prior authorizations are needed, flag COB issues, and update patient demographics in the practice management system.

Qualifications

• 1+ year of insurance verification or front-end billing experience.
• Familiarity with payer portals, Availity and real-time eligibility (270/271).
• Understanding of HMO, PPO, EPO, Medicare Advantage and Medicaid plans.
• Ability to work quickly and accurately due to long schedules.

Responsibilities

• Verify active coverage for scheduled patients before their appointments.
• Confirm benefits for service type (copay, coinsurance, deductible).
• Determine if prior authorization or referral is needed and route accordingly.
• Identify COB issues and the correct primary payer.
• Update demographics and insurance details in the practice management system.
• Flag out-of-network or inactive coverage before visits.
• Note behavioral health carve-outs and plan-specific mental health benefits.

Skills

Insurance verification

Front-end billing experience

Payer portals proficiency

Attention to detail

Tools

Availity

270/271 eligibility tools

Job description

Insurance Eligibility & Benefits Verification Specialist (Remote)

Check every patient's coverage and benefits before the visit, so the practice knows what to collect and claims don't deny for eligibility after the fact.

Eligibility denials are the easiest denials to prevent and among the most common. Coverage changes, plans terminate, a secondary becomes primary, and nobody notices until the claim comes back. As an eligibility and benefits verification specialist you check before the visit, so the front desk knows what to collect and the claim goes to the right payer.

What you will do

• Verify active coverage for scheduled patients ahead of their appointments
• Confirm benefits for the service type: copay, coinsurance, deductible met, visit limits
• Check whether the service needs prior authorization or a referral and hand it off
• Identify coordination-of-benefits issues and the correct primary payer
• Update demographics and insurance details in the practice management system
• Flag out-of-network and inactive coverage to the practice before the visit
• Note behavioral health carve-outs and plan-specific mental health benefits

What you need

• One or more years of insurance verification, patient access or front-end billing
• Experience with payer portals, Availity and real-time eligibility (270/271) tools
• Understanding of HMO, PPO, EPO, Medicare Advantage and Medicaid managed care plans
• Speed with accuracy — schedules are long and visits are close