Insurance Verification & Authorization Specialist

Better Health Supplies, Inc.; Birmingham (AL); On-site; USD 28,000 - 39,000; Full time

Job summary

Better Health Supplies, Inc. is seeking an experienced Insurance Verification & Authorization Specialist to support our revenue cycle and patient intake operations in Birmingham, AL.

The role focuses on verifying insurance eligibility, determining prior authorization requirements, obtaining authorizations, and submitting PCP referrals while maintaining HIPAA-compliant records. The ideal candidate will have strong attention to detail and excellent communication with insurers, provider offices,

Qualifications

• Previous hands-on experience in the medical field is required.
• Must be available to work on-site in Birmingham, AL, for a minimum of 30 hours per week.
• Experience with medical insurance eligibility and benefits verification.
• Experience checking and obtaining prior authorizations.
• Experience submitting PCP referrals and following up with provider offices.
• Knowledge of commercial insurance and government healthcare plans, such as Medicare and Medicaid.
• Understanding of in-network benefits, deductibles, coinsurance, referral requirements, and authorization processes.
• Strong organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Ability to manage multiple requests and follow up on outstanding items without constant supervision.
• Proficiency with computers, spreadsheets, and electronic documentation systems.
• Ability to handle confidential patient information in accordance with HIPAA requirements.

Responsibilities

• Verify patients' insurance eligibility and active coverage.
• Review insurance benefits, including deductibles, copayments, coinsurance, and out-of-pocket expenses.
• Confirm in-network and out-of-network benefits and provider participation.
• Identify coverage limitations, exclusions, and payer-specific requirements.
• Determine whether prior authorizations or PCP referrals are required.
• Document verification results accurately in the appropriate systems.
• Communicate insurance findings and potential patient financial responsibilities to the appropriate internal teams.
• Review insurance policies to determine prior authorization requirements for medical services, supplies, or DME.
• Submit authorization requests with the required documentation.
• Follow up with insurance companies and utilization management departments regarding pending authorizations.
• Track authorization status, approval dates, expiration dates, and approved service periods.
• Identify missing documentation or additional information needed to complete authorization requests.
• Escalate delayed, denied, or urgent authorization requests as needed.
• Maintain accurate records of authorization submissions, follow-ups, and payer responses.
• Communicate authorization updates and requirements to internal departments.
• Verify whether a patient's insurance plan requires a referral from their PCP.
• Contact PCP offices to request and obtain required referrals.
• Submit referral requests and supporting documentation according to payer requirements.
• Follow up with provider offices and insurance companies on outstanding referrals.
• Track referral submission dates, approval status, effective dates, and expiration dates, when applicable.
• Resolve referral issues, including missing information, incorrect provider details, and processing delays.
• Ensure referrals are documented and available before proceeding with applicable services or orders.
• Maintain accurate and timely documentation in electronic systems.
• Manage assigned work queues and prioritize pending requests based on urgency and aging.
• Communicate professionally with insurance representatives, medical offices, and internal teams.
• Follow established workflows and payer-specific guidelines.
• Identify recurring insurance, authorization, and referral issues and report them to management.
• Protect confidential patient information and comply with HIPAA requirements.

Skills

Medical field experience

Insurance verification

Prior authorizations

PCP referrals coordination

Organizational skills

Communication skills

Multitasking

Tools

EHR systems

CRM platforms

Ticketing systems

Practice management software

Job description

Everyone deserves easy and cost-effective healthcare. At Better Health our mission is to bring transparency, access, and support to people managing chronic conditions at home.

Our diverse team is united by our shared values of open dialogue, creativity, collaboration, and radical transparency.If you're fired up at the thought of revitalizing a sleepy $60 billion industry and passionate about user-focused solutions, join us!

Insurance Verification & Authorization Specialist

Location

Birmingham, AL

Location Type

On-site

Job Summary

We are seeking an experienced Insurance Verification & Authorization Specialist with a strong background in the medical field to support our revenue cycle and patient intake operations. The ideal candidate will have hands-on experience verifying insurance benefits, checking authorization requirements, obtaining prior authorizations, and submitting and following up on Primary Care Provider (PCP) referrals.

This role requires strong attention to detail, excellent communication skills, and the ability to follow up consistently with insurance companies, provider offices, and internal teams to ensure all requirements are met before services or equipment are provided.

Previous experience in medical insurance verification, prior authorizations, and PCP referral coordination is required.

Key Responsibilities

1. Insurance Verification

Verify patients' insurance eligibility and active coverage.

Review insurance benefits, including deductibles, copayments, coinsurance, and out-of-pocket expenses.

Confirm in-network and out-of-network benefits and provider participation.

Identify coverage limitations, exclusions, and payer-specific requirements.

Determine whether prior authorizations or PCP referrals are required.

Document verification results accurately in the appropriate systems.

Communicate insurance findings and potential patient financial responsibilities to the appropriate internal teams.

2. Authorization Checks and Follow-Ups

Review insurance policies to determine prior authorization requirements for medical services, supplies, or durable medical equipment (DME).

Submit authorization requests with the required documentation.

Follow up with insurance companies and utilization management departments regarding pending authorizations.

Track authorization status, approval dates, expiration dates, and approved service periods.

Identify missing documentation or additional information needed to complete authorization requests.

Escalate delayed, denied, or urgent authorization requests as needed.

Maintain accurate records of authorization submissions, follow-ups, and payer responses.

Communicate authorization updates and requirements to internal departments.

3. PCP Referral Submissions and Follow-Ups

Verify whether a patient's insurance plan requires a referral from their Primary Care Provider (PCP).

Contact PCP offices to request and obtain required referrals.

Submit referral requests and supporting documentation according to payer requirements.

Follow up with provider offices and insurance companies on outstanding referrals.

Track referral submission dates, approval status, effective dates, and expiration dates, when applicable.

Resolve referral issues, including missing information, incorrect provider details, and processing delays.

Ensure referrals are documented and available before proceeding with applicable services or orders.

4. Documentation and Communication

Maintain accurate and timely documentation in electronic systems.

Manage assigned work queues and prioritize pending requests based on urgency and aging.

Communicate professionally with insurance representatives, medical offices, and internal teams.

Follow established workflows and payer-specific guidelines.

Identify recurring insurance, authorization, and referral issues and report them to management.

Protect confidential patient information and comply with HIPAA requirements.

Required Qualifications

Previous hands-on experience in the medical field is required.

Must be available to work on-site in Birmingham, AL, for a minimum of 30 hours per week.

Experience with medical insurance eligibility and benefits verification.

Experience checking and obtaining prior authorizations.

Experience submitting PCP referrals and following up with provider offices.

Knowledge of commercial insurance and government healthcare plans, such as Medicare and Medicaid.

Understanding of in-network benefits, deductibles, coinsurance, referral requirements, and authorization processes.

Strong organizational skills and attention to detail.

Excellent written and verbal communication skills.

Ability to manage multiple requests and follow up on outstanding items without constant supervision.

Proficiency with computers, spreadsheets, and electronic documentation systems.

Ability to handle confidential patient information in accordance with HIPAA requirements.

Preferred Qualifications

Experience working with durable medical equipment (DME), medical supplies, or healthcare revenue cycle operations.

Experience with insurance portals and eligibility verification tools.

Familiarity with electronic health records (EHRs), practice management systems, and ticketing or CRM platforms.

Experience working directly with insurance companies, medical offices, and provider referral departments.

Our Office

A note from our CEO:

When I developed an innovative urinary catheter almost 9 years ago, I could have never imagined that accessing life-saving and novel medical supplies would be so difficult for so many people. With endless options, yet little guidance, choosing a trustworthy supplier and the right medical product can be incredibly challenging.
In the years of bringing our catheter to market, I spoke to thousands of customers, who shared story after story about their difficulties. These conversations, coupled with my experience as a device manufacturer became the seed of Better Health. Today, Better Health has grown into a much bigger vision: a company that enables consumer choice and transparency at each step in the process, and works alongside manufacturers to help them bring innovative medical products directly to the people that need them.
We’re creating a solution that modernizes the entire process of discovering, choosing, and receiving medical supplies. We do so while educating, coaching and supporting our members and helping them save costs along the way.We believe in providing care that meets your needs from start to finish. From product discovery, delivery and ongoing support, we’re here to help you get back to the important things in life.
Our goal is to be your partner throughout this journey and to make it as easy and seamless as possible. Our line is always open. Please feel free to contact us with any questions or suggestions. We want to work together to make Better Health even better for you!