Insurance Verification Lead - Eagle or Summit County, CO

VAIL-SUMMIT ORTHOPAEDICS PC•Edwards, CO

19h•$24 - $31•Hybrid

About The Position

The Insurance Verification Lead oversees front-end revenue cycle workflows that occur prior to claim submission, including insurance verification, coordination of benefits (COB), registration accuracy, financial clearance, and point-of-service collections. This role provides oversight, standardization, training, auditing, and accountability for front-end operational workflows across VSON locations. While the position may provide occasional operational coverage, the primary focus is process ownership, workflow improvement, staff development, performance monitoring, and ensuring accurate patient intake and financial clearance processes. The role works closely with front desk teams, operational leadership, billing partners, and clinical departments to support clean claims, reduce preventable denials, and improve patient financial workflows.

Requirements

3+ years of experience in a healthcare patient access, front desk, or revenue cycle role in a physician practice or clinic setting.
Strong working knowledge of insurance verification, COB, eligibility, and prior authorization processes.
Experience training and holding staff accountable to registration and insurance capture standards.
Familiarity with payer portals and how to use them for eligibility and COB verification.
Proficiency with practice management or EHR systems (eClinicalWorks preferred).
Strong attention to detail and collaborative communication style.

Nice To Haves

Experience in orthopedic, surgical, or multi-specialty practice settings.
Familiarity with denial reporting and root cause analysis from a vendor partner.
Experience managing prior authorization workflows for therapy and surgical services.

Responsibilities

Establish and maintain patient registration accuracy standards across all locations.
Set and maintain clear standards for insurance card capture, insurance entry into eCW, and insurer selection.
Conduct ongoing training and accountability follow-up with front desk staff on registration standards.
Perform monthly front-end quality audits; use denial data from Synergen to identify patterns and target training.
Track and report front-end error rates; set reduction targets and monitor progress.
Oversee and standardize eligibility verification workflows to ensure coverage is verified prior to service.
Develop and implement a COB correction and resolution workflow, including real-time fixes and post-denial feedback loops.
Translate denial trend data from Synergen into specific front-end training actions with clear timelines.
Collaborate with the authorization team to ensure front-end workflows support timely and accurate authorization processing.
Verify therapy benefits and authorization units upfront for all therapy patients, including unit limits, applicable dates of service, and plan limits.
Monitor validity of existing authorizations covering continuous services (physical therapy, routine injections).
Manage referral requirements by payer; ensure referring provider information is complete and accurate at scheduling.
Own the patient estimate and financial clearance process prior to service.
Monitor and improve point-of-service collection workflows, training, and performance metrics.
Manage hospital discounted care workflows as appropriate.
Support Synergen on unresolved patient AR issues where front-end information is needed.
Serve as the liaison between clinical operations and billing for front-end workflow changes — especially when payer rules change.
Ensure scheduling rules and patient access workflows support clean intake.
Review Synergen’s monthly front-end performance summary and implement corrective actions, workflow improvements, and staff training as needed.
Participate in the weekly RCM operating review; report on front-end metrics and action items.
Escalate persistent front-end issues to the RCM Leader and operations leadership with specific corrective action recommendations.