Insurance Verification Specialist - Hybrid

Ohio Society of CPAs; Dallas (TX); On-site; USD 35,000 - 50,000; Full time

Job summary

The Insurance Verification Specialist 1 at a leading healthcare organization provides critical insurance benefit information. Responsible for verifying coverage and ensuring timely financial clearance, this entry-level position is essential for supporting patient care and organizational reimbursement.

Benefits

401(k) savings plan with dollar-for-dollar match up to 5%

Tuition Reimbursement

PTO accrual beginning Day 1

Immediate eligibility for health and welfare benefits

Qualifications

• 1 year of healthcare or customer service experience preferred.
• Ability to manage multiple, changing priorities effectively.

Responsibilities

• Verifying insurance eligibility and benefits for scheduled and unscheduled patient accounts.
• Calculating patient financial responsibility based on payer coverage.

Skills

Communication

Data Entry

Empathy

Education

H.S. Diploma/GED Equivalent

Tools

Microsoft Office

Job description

Description

JOB SUMMARY: The Insurance Verification Specialist 1, under general supervision, provides patients, physicians, and internal hospital personnel with insurance benefit information. This position ensures timely verification of insurance benefits and financial clearance, directly impacting the organization's reimbursement from payers for scheduled and unscheduled patient accounts.

ESSENTIAL FUNCTIONS OF THE ROLE:

1. Performs financial clearance of patient accounts by verifying insurance eligibility and benefits, ensuring all notifications and authorizations are completed within the required timeframe.
2. Completes appropriate payor forms related to notification and authorization.
3. Coordinates the submission of clinical documentation from physicians to payers for authorization needs.
4. Calculates accurate patient financial responsibility.
5. Communicates timely with Utilization Review and collaborates effectively with physician and facility staff to ensure financial clearance of the patient's account prior to scheduled or unscheduled service during the patient's hospital stay.
6. Interprets complex payer coverage information, including network participation status, plan coverage limitations, and inactive benefits.
7. Documents systems according to Insurance Verification guidelines to assure accurate and timely reimbursement.

KEY SUCCESS FACTORS:

1. 1 year of healthcare or customer service experience preferred.
2. Ability to meet performance standards of production, accuracy, completeness, and quality.
3. Knowledge of payer guidelines by plan and service type.
4. Good listening and communication skills, with professional telephone etiquette.
5. Ability to maintain professionalism in stressful and emotional environments, including behavioral health and life-or-death situations.
6. High level of empathy and effective communication with patients and families during traumatic events.
7. Ability to manage multiple, changing priorities effectively and organized.
8. Excellent data entry, numeric, typing, and computer navigation skills.
9. Basic computer skills and familiarity with Microsoft Office.

BENEFITS:

• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1

QUALIFICATIONS:

• Education: H.S. Diploma/GED Equivalent
• Experience: Less than 1 Year of Experience

Note: Benefits may vary based on position type and level.