Remote Medical Benefit Verification Specialist

Community Health Systems; United States; Remote; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking a Remote Medical Benefit Verification Specialist to join their team. This entry-level role is essential for ensuring accurate insurance verification and authorization processes, which are crucial for smooth billing and reimbursement. The specialist will interact with patients, physician offices, and internal departments to secure necessary approvals and communicate financial responsibilities. If you're detail-oriented and have a passion for healthcare, this is a fantastic opportunity to start your career in a supportive and dynamic environment.

Qualifications

• 1-2 years of experience in insurance verification or healthcare financial services.
• Strong understanding of medical benefit plans and payer requirements.

Responsibilities

• Verify insurance benefits and eligibility for scheduled patients.
• Coordinate with physician offices to resolve authorization issues.

Skills

Insurance Verification Processes

Medical Benefit Plans

Payer Authorization Requirements

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

Insurance Payer Portals

Job description

Remote Medical Benefit Verification Specialist

Job Summary
The Remote Benefit Verification Specialist 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

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

Qualifications

• H.S. Diploma or GED required
• Associate Degree in Healthcare Administration, Business, or related field preferred
• 1-2 years of experience in insurance verification, patient access, medical billing, or healthcare financial services required
• Experience 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 EMR, financial systems, and patient scheduling software.
• Excellent communication and customer service skills.
• Strong attention to detail for accuracy in verification and documentation.
• Ability to work independently and prioritize tasks in a fast-paced environment.
• Knowledge of HIPAA regulations and patient confidentiality.

Additional Details

• Seniority level: Entry level
• Employment type: Full-time
• Job function: Health Care Provider
• Industries: Hospitals and Health Care