Insurance Verification/Eligibility Specialist

ADP, Inc.; Winter Haven (FL); On-site; USD 25,000 - 34,000; Full time

Benefits offered by this job

401(k)

401(k) Matching

Health Insurance

Paid Time Off

Paid Training

Professional Development Assistance

Referral Program

Job summary

Eye Specialists of Mid‑Florida P.A. is seeking an Insurance Verification/Eligibility Specialist to ensure accurate patient insurance data prior to services.

The role supports revenue cycle by confirming coverage, benefits, and authorizations through payer portals, calls, and electronic systems. Key duties include verifying eligibility, updating records, obtaining information, and communicating findings to patients and internal teams.

Qualifications

• High School Diploma or equivalent required.
• 1 year insurance verification experience preferred.
• 1 year medical billing or revenue cycle experience preferred.
• Experience with insurance payer websites and electronic verification systems preferred.
• Knowledge of commercial and government insurance plans preferred.
• Ophthalmology or other specialty healthcare experience preferred.

Responsibilities

• Verify patient eligibility, insurance coverage, benefits, effective dates, deductibles, copayments, coinsurance, limitations, exclusions, and other applicable payer requirements.
• Confirm the accuracy of patient demographic and insurance information and update systems as necessary.
• Obtain and document insurance information using payer websites, electronic systems, telephone calls, and other approved resources.
• Identify inactive coverage, discrepancies, missing information, coordination of benefits issues, and other insurance-related concerns and communicate them to the appropriate department for resolution.
• Review insurance requirements for referrals, authorizations, precertifications, and other payer-specific requirements.
• Enter and maintain accurate insurance and patient information in applicable systems and databases.
• Process insurance verification requests and address verification rejections or discrepancies in a timely manner.
• Review and maintain documentation in accordance with departmental procedures and payer requirements.
• Research payer policies, benefits, and coverage requirements as needed to support accurate patient and insurance information.
• Communicate insurance verification findings clearly and professionally to patients, providers, and internal departments as appropriate.
• Work closely with Scheduling, Patient Care, Billing, and other departments to ensure insurance information is accurate and available for timely claims processing.
• Assist in identifying and resolving insurance-related issues that may delay billing, claims submission, reimbursement, or collection.
• Maintain accurate and organized records of insurance verification activities and related documentation.
• Protect the confidentiality and security of patient, insurance, financial, and business information in accordance with HIPAA and ESMF policies and procedures.
• Assist management with the development and improvement of departmental procedures by providing feedback and information related to insurance verification processes.
• Maintain knowledge of payer requirements, insurance policies, and changes that may affect eligibility, benefits, verification, and reimbursement.
• Meet established departmental productivity, quality, accuracy, and turnaround-time expectations.
• Perform other duties and responsibilities as assigned by management.

Skills

Insurance verification

Attention to detail

HIPAA awareness

Communication skills

Data entry

Confidentiality

Education

High School Diploma

1 year insurance verification experience

1 year medical billing experience

Experience in medical office/ revenue cycle

Payer websites / verification systems experience

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Insurance Verification/Eligibility Specialist

Qsz-wh-ins Verification Regular - Hourly Full-Time Clerical Winter Haven, FL, US

JOB SUMMARY

The Insurance Verification Specialist is responsible for accurately and timely verifying patient insurance eligibility, coverage, benefits, and authorization requirements prior to services being rendered. This position plays an important role in supporting the revenue cycle by ensuring patient insurance information is complete, current, and properly documented to facilitate accurate billing and timely claims submission.

The Insurance Verification Specialist researches and confirms insurance information through payer websites, electronic systems, telephone communication, and other available resources. The position identifies coverage limitations, discrepancies, inactive coverage, and other insurance-related issues and communicates findings to the appropriate departments for resolution.

The Insurance Verification Specialist works closely with Scheduling, Patient Care, Billing, and other departments to ensure accurate insurance information is available throughout the patient’s experience. This position requires strong attention to detail, knowledge of insurance terminology and payer requirements, effective communication skills, and the ability to manage multiple priorities in a fast‑paced healthcare environment while maintaining accuracy and confidentiality.

PRIMARY RESPONSIBILITIES

• Verify patient eligibility, insurance coverage, benefits, effective dates, deductibles, copayments, coinsurance, limitations, exclusions, and other applicable payer requirements.
• Confirm the accuracy of patient demographic and insurance information and update systems as necessary.
• Obtain and document insurance information using payer websites, electronic systems, telephone calls, and other approved resources.
• Identify inactive coverage, discrepancies, missing information, coordination of benefits issues, and other insurance‑related concerns and communicate them to the appropriate department for resolution.
• Review insurance requirements for referrals, authorizations, precertifications, and other payer‑specific requirements.
• Enter and maintain accurate insurance and patient information in applicable systems and databases.
• Process insurance verification requests and address verification rejections or discrepancies in a timely manner.
• Review and maintain documentation in accordance with departmental procedures and payer requirements.
• Research payer policies, benefits, and coverage requirements as needed to support accurate patient and insurance information.
• Communicate insurance verification findings clearly and professionally to patients, providers, and internal departments as appropriate.
• Work closely with Scheduling, Patient Care, Billing, and other departments to ensure insurance information is accurate and available for timely claims processing.
• Assist in identifying and resolving insurance‑related issues that may delay billing, claims submission, reimbursement, or collection.
• Maintain accurate and organized records of insurance verification activities and related documentation.
• Protect the confidentiality and security of patient, insurance, financial, and business information in accordance with HIPAA and ESMF policies and procedures.
• Assist management with the development and improvement of departmental procedures by providing feedback and information related to insurance verification processes.
• Maintain knowledge of payer requirements, insurance policies, and changes that may affect eligibility, benefits, verification, and reimbursement.
• Meet established departmental productivity, quality, accuracy, and turnaround‑time expectations.
• Perform other duties and responsibilities as assigned by management.

EDUCATION, EXPERIENCE, LICENSES & CERTIFICATIONS

• High School Diploma or equivalent required.
• One (1) year of insurance verification experience preferred.
• One (1) year of medical billing or healthcare revenue cycle experience preferred.
• Previous experience in a medical office, healthcare, insurance, or revenue cycle environment preferred.
• Experience working with insurance payer websites and electronic verification systems preferred.
• Knowledge of commercial and government insurance plans preferred.
• Ophthalmology or other specialty healthcare experience preferred.

KNOWLEDGE, SKILLS & ABILITIES

• Knowledge of health insurance eligibility, benefits, coverage, and payer requirements.
• Strong attention to detail and accuracy when reviewing and entering information.
• Ability to research, interpret, and document insurance information.
• Ability to identify discrepancies and resolve or appropriately elevate insurance‑related issues.
• Excellent verbal and written communication skills.
• Strong organizational and time‑management skills.
• Ability to prioritize and manage multiple tasks in a fast‑paced environment.
• Ability to work independently while contributing effectively to a team.
• Ability to maintain accuracy and professionalism while working under pressure.
• Proficient computer skills and ability to learn and use multiple software applications and electronic systems.
• Ability to maintain strict confidentiality of patient and company information.
• Demonstrated professionalism and effective interpersonal skills when communicating with patients, team members, insurance representatives, and other departments.

PHYSICAL REQUIREMENTS

• Ability to sit for extended periods while performing computer and telephone‑based work.
• Ability to stand, walk, bend, reach, and perform routine office activities as needed.
• Frequent use of a computer, keyboard, telephone, and other standard office equipment.
• Ability to communicate effectively in person and by telephone.
• Ability to see clearly at close and intermediate distances for computer work and document review.
• Ability to work in a typical office environment with moderate noise levels.

Reasonable accommodation may be provided to enable individuals with disabilities to perform the essential functions of the position.

CONFIDENTIALITY & COMPLIANCE

The Insurance Verification Specialist is expected to maintain the confidentiality and security of patient, insurance, financial, and business information. The position must comply with HIPAA, applicable federal and state requirements, ESMF policies and procedures, and all applicable departmental standards.

BENEFITS

• 401(k)
• 401(k) Matching
• AD&D Insurance
• Health Insurance
• Disability Insurance
• Vision Benefits & Discounted Services
• Employee Assistance Program
• Life Insurance
• Opportunities for Advancement
• Paid Time Off
• Paid Training
• Professional Development Assistance
• Referral Program

JOB TYPE

• Full‑time
• 8‑hour shifts

WORK LOCATION

OTHER

This job description is intended only to describe the general nature and level of work performed. The Call Center Scheduling Specialist must be able to travel to various satellite locations as needed for work assignments. A valid Florida driver’s license is required. This job descriptionis not intended nor should it be interpreted as an exhaustive list of all duties, skills and responsibilities. The Call Center Scheduling Specialist will perform all duties listed in this job description as well as any other assigned by the Manager and physicians. Overtime may be required.

EQUAL EMPLOYMENT OPPORTUNITY STATEMENT

Eye Specialists of Mid‑Florida P.A. is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. We are a drug and tobacco‑free workplace.