Insurance Benefits Specialist

DrSnip-posted about 20 hours ago
Full-time • Entry Level
Remote • Seattle, WA
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The Insurance Benefits & Estimates Specialist plays a critical role in ensuring patients have a clear understanding of their insurance coverage and expected costs before their vasectomy procedure. This position combines analytical precision, customer service excellence, and in-depth insurance knowledge to deliver accurate benefit estimates, verify coverage, obtain pre-authorizations, and help maximize insurance reimbursement for both the clinic and the patient.

  • Estimate Patient Financial Responsibility: Review patient insurance benefits and calculate estimated out-of-pocket costs (deductibles, copayments, and coinsurance) for vasectomy and related services.
  • Verify Insurance Coverage: Contact insurance carriers to confirm eligibility, coverage details, and pre-authorization requirements for upcoming procedures.
  • Obtain Pre-Authorizations: Facilitate the prior authorization process by submitting necessary clinical and coding documentation (CPT and ICD-10 codes) to ensure timely insurance approval.
  • Communicate with Patients: Clearly explain insurance coverage and cost estimates, answer questions, and help patients understand their financial responsibility in a professional and empathetic manner.
  • Resolve Claims and Billing Issues: Collaborate with the billing department and insurance carriers to address claim denials, underpayments, or discrepancies, ensuring accurate and timely resolution.
  • Maintain Accurate Documentation: Enter and update insurance and benefit information in the clinic’s electronic health record (EHR) and billing systems with precision and confidentiality.
  • Ensure Compliance: Adhere to HIPAA and all applicable federal and state regulations in handling patient information and insurance data.
  • Track and follow up on unresolved billing issues, assist with resolution of claims appeals and reconsiderations.
  • Contribute to Continuous Improvement: Identify trends in coverage, denials, and patient concerns to recommend process improvements and enhance patient satisfaction.
  • High School Diploma required. Some college preferred. Equivalent experience in a medical billing or insurance verification role may be considered.
  • Minimum of 1 year in medical insurance verification, benefits coordination, or healthcare billing.
  • General proficiency in medical terminology
  • Proficient in navigation of various insurance portals, EHR platforms, and Microsoft Excel.
  • Familiarity with CPT and ICD-10 coding, coordination of benefits, and payer-specific policies.
  • Strong understanding of HIPAA, ACA, and general medical billing best practices.
  • Exceptional communication and customer service skills.
  • High attention to detail and accuracy.
  • Strong foundational math skills, analytical, and problem-solving ability.
  • Ability to work independently while contributing to a collaborative team environment.
  • Experience in a specialty clinic setting (urology, reproductive health, or outpatient surgical services) is a plus.
  • Generous PTO policy
  • Retirement Match
  • Comprehensive Healthcare Coverage
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