Prior Authorization & VOB Specialist

Rcmbilling; United States; On-site; USD 60,000 - 80,000; Full time

Job summary

Rcmbilling is seeking a detail-oriented Insurance Verification Specialist to verify patient insurance coverage for procedures, using real-time EDI 270/271 transactions and payer phone calls.

You will verify primary, secondary, and tertiary coverage, active dates, copays, deductibles, and out-of-pocket maximums, and initiate prior authorizations for outpatient procedures, surgeries, MRI/CT scans, and specialty medications.

Qualifications

• 2+ years experience in US healthcare insurance verification and prior authorization.
• Experience with CoverMyMeds, Availity, Carelon, eviCore, and payer-specific authorization portals.
• Familiarity with medical terminology, ICD-10 diagnosis codes, and CPT surgical codes.
• Proactive communication skills to follow up with payers and notify clinical coordinators.

Responsibilities

• Verify patient insurance coverage before procedures using real-time 270/271 EDI transactions and payer calls.
• Verify primary, secondary, and tertiary coverage, policy active dates, copays, deductibles, and out-of-pocket maximums.
• Initiate and secure prior authorizations for complex outpatient procedures, surgeries, MRI/CT scans, and specialty medications.

Skills

Insurance verification

Prior authorization

Tools

CoverMyMeds

Availity

Carelon

eviCore

payer portals

Job description

Verify patient insurance coverage, obtain prior authorizations and confirm benefit limits before procedures take place.

What you will do

• Perform comprehensive Verification of Benefits (VOB) via real-time 270/271 EDI transactions and payer phone calls.
• Verify primary, secondary, and tertiary coverage, policy active dates, copays, deductibles, and out-of-pocket maximums.
• Initiate and secure prior authorizations for complex outpatient procedures, surgeries, MRI/CT scans, and specialty medications.

What we are looking for

• 2+ years experience in US healthcare insurance verification and prior authorization.
• Experience with CoverMyMeds, Availity, Carelon, eviCore, and payer-specific authorization portals.
• Familiarity with medical terminology, ICD-10 diagnosis codes, and CPT surgical codes.
• Proactive communication skills to follow up with payers and notify clinical coordinators.