Insurance Verification Specialist

Caron Treatment Centers; Wernersville (Berks County); In loco; USD 42.000 - 64.000; Tempo pieno

Descrizione del lavoro

Caron Treatment Centers is seeking an Insurance Verification Specialist to join our patient access team in Wernersville, PA. You will verify coverage, determine eligibility, and communicate benefits to admissions and financial services to support timely admissions and informed planning.

The role requires careful attention to detail, proficiency with payer portals and EMR systems, and the ability to manage high-volume workloads while delivering patient-centered service.

Competenze

• ASAM level of placement criteria knowledge is preferred.
• Proficiency with payer portals and EMR systems.
• Strong understanding of insurance benefits and eligibility verification.

Mansioni

• Complete comprehensive insurance verification for all scheduled and prospective admissions.
• Validate eligibility, effective dates, deductibles, out-of-pocket maximums, coinsurance, copayments, lifetime benefits, and policy limitations.
• Verify behavioral health and substance use disorder benefits.
• Identify network status and out-of-network benefit structures.
• Confirm authorization requirements for all levels of care.

Conoscenze

ASAM criteria knowledge

Microsoft Office proficiency

Strong verbal and writtenCommunication

Ability to work independently

Time management

Formazione

High School Diploma or GED

Strumenti

Payer portals

Electronic Medical Records (EMR) systems

Insurance claim systems

Microsoft Excel

Descrizione del lavoro

Join a team where your work truly makes a difference. For nearly 70 years, Caron Treatment Centers has helped individuals and families find hope, healing, and lasting recovery through compassionate, evidence-based addiction and behavioral healthcare. At Caron, employees are supported with opportunities to learn, grow, and build meaningful careers, along with competitive pay, comprehensive benefits, generous paid time off, tuition reimbursement, and a 401(k) plan.

We’re proud to foster a supportive, collaborative workplace where employees feel valued and connected to our mission. That commitment has earned Caron multiple national and regional Top Workplace recognitions, including being named a USA TODAY Top Workplace for 2026.

Join us to build a career with purpose, growth, and impact at Caron.

Duties and Responsibilities:

• Complete comprehensive insurance verification for all scheduled and prospective admissions.
• Validate eligibility, effective dates, deductibles, out-of-pocket maximums, coinsurance, copayments, lifetime benefits, and policy limitations.
• Verify behavioral health and substance use disorder benefits.
• Identify network status, single case agreement requirements, and out-of-network benefit structures.
• Confirm authorization requirements for all levels of care.
• Research coordination of benefits, secondary insurance coverage, and payer-specific requirements.
• Escalate complex insurance issues when appropriate.
• Calculate and communicate estimated patient financial responsibility.
• Collaborate with Financial Counselors to ensure informed financial planning prior to admission.
• Provide accurate and timely benefit information to Admissions, Intake, Utilization Management, and Revenue Cycle teams.
• Ensure all insurance verification outcomes are documented within designated systems.
• Maintain productivity standards and established turnaround times.
• Participate in daily huddles, team meetings, and workflow management activities.
• Assist with urgent admissions and same-day verification requests.
• Serve as a primary resource for insurance benefit questions.
• Communicate professionally with patients, families, insurance representatives, referral sources, and internal departments.
• Provide clear explanations regarding benefits, financial obligations, and authorization requirements.
• Maintain a patient-centered and service-oriented approach in all interactions.
• Prioritize workload based on admission volume, scheduled admissions, payer requirements, and urgent patient needs.
• Serve as the primary escalation point for complex insurance verification issues and payer-related concerns.
• Support financial counseling processes by providing accurate insurance benefit information.
• Collaborate with patient financial services teams to facilitate collection planning and financial arrangements.
• Ensure patients and families receive accurate information regarding expected financial obligations.
• This job description reflects management’s assignment of essential functions; it does not prescribe or restrict the duties or tasks that may be required or assigned.

Physical Requirements:

The physical and mental demands described here are representative of those that must be met to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to sit, use telephone and computer at least 85% of workday
• Ability to verbally communicate 85% of workday
• Ability to type 80% of workday

EDUCATION / EXPERIENCE QUALIFICATIONS:

• ASAM Level of placement criteria, knowledge of medical necessity
• High School Diploma or GED.
• Minimum one year of insurance verification, patient access, admissions, healthcare revenue cycle, or related healthcare experience.
• Working knowledge of commercial insurance, , and managed care plans.
• Proficiency with Microsoft Office applications.

Knowledge, skills and abilities:

• Strong understanding of insurance benefits and eligibility verification.
• Excellent verbal and written communication skills.
• Critical thinking and problem-solving abilities.
• Strong organizational and time-management skills.
• Ability to work independently while managing high-volume workloads.
• Attention to detail and commitment to accuracy.
• Proficiency with payer portals and electronic medical records.
• Ability to collaborate effectively across departments.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.