Remote Benefit Verification Specialist

Community Health Systems; United States; Remote; USD 50,000 - 75,000; Full time

Job summary

Community Health Systems is seeking a Remote Benefit Verification Specialist responsible for verifying insurance benefits and managing authorizations. The role involves interacting with patients and physician offices to ensure smooth billing processes. Applicants should have experience in insurance verification and excellent communication skills.

Qualifications

• 1-2 years of experience in insurance verification or related field.
• Experience with EMR and patient scheduling systems preferred.

Responsibilities

• Verify insurance benefits and authorization requirements.
• Coordinate with physician offices and patients for approvals.
• Track authorizations and maintain compliance.

Skills

Insurance verification processes

Excellent communication

Customer service skills

Attention to detail

Education

H.S. Diploma or GED

Associate Degree in Healthcare Administration

Tools

Electronic Medical Records (EMR)

Patient scheduling systems

Job description

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Job Summary

The Benefit Verification Representative is responsible for verifying insurance benefits, eligibility, and authorization requirements to ensure accurate billing and reimbursement for procedures and services. This role interacts with physician offices, patients, and internal departments to coordinate insurance approvals, obtain necessary referrals and authorizations, and communicate patient financial responsibilities. The Insurance Verification Representative ensures compliance with payer guidelines and facilitates a smooth scheduling and billing process for patients.

Job Summary

The Benefit Verification Representative is responsible for verifying insurance benefits, eligibility, and authorization requirements to ensure accurate billing and reimbursement for procedures and services. This role interacts with physician offices, patients, and internal departments to coordinate insurance approvals, obtain necessary referrals and authorizations, and communicate patient financial responsibilities. The Insurance Verification Representative ensures compliance with payer guidelines and facilitates a smooth scheduling and billing process for patients.

Essential Functions

• Verifies insurance benefits, eligibility, and pre-determination requirements for all scheduled patients to ensure coverage and minimize claim denials.
• Confirms that the correct insurance package has been loaded into the patient's chart and updates records as needed.
• Reviews provider schedules in the electronic medical record system to obtain referrals for HMO patients and authorizations for procedures and radiology testing.
• Works with hospital radiology and scheduling teams to ensure all necessary authorizations are secured for upcoming procedures.
• Reviews the authorization/referral list in the patient financial system (e.g., Athena) and attaches required authorizations and referrals to pending appointments.
• Utilizes financial and scheduling systems to generate authorizations, verify patient coverage, and ensure all necessary approvals are documented.
• Tracks and monitors authorizations and referrals, ensuring compliance with benchmark data and payer requirements.
• Coordinates with physician offices to resolve issues related to pre-determinations and authorization delays.
• Contacts patients in advance of procedures to notify them of estimated financial responsibility and available payment options.
• Assists and provides backup support for other business office positions as needed.
• Performs other duties as assigned.
• Complies with all policies and standards.
  
  

Qualifications

• H.S. Diploma or GED required
• Associate Degree in Healthcare Administration, Business, or a related field preferred
• 1-2 years of experience in insurance verification, patient access, medical billing, or healthcare financial services required
• Experience working with electronic medical records (EMR), patient scheduling systems, and insurance payer portals. preferred
  
  

Knowledge, Skills And Abilities

• Strong understanding of insurance verification processes, medical benefit plans, and payer authorization requirements.
• Knowledge of healthcare reimbursement practices, including prior authorization and referral processes.
• Proficiency in electronic medical records (EMR), financial systems, and patient scheduling software.
• Excellent communication and customer service skills to interact professionally with patients, physician offices, and payers.
• Strong attention to detail to ensure accuracy in insurance verification and documentation.
• Ability to work independently and prioritize tasks in a fast-paced environment.
• Knowledge of HIPAA regulations and patient confidentiality requirements.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Human Resources

• Industries

  Hospitals and Health Care

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