Insurance Verification Specialist

ActivStyle•Minneapolis-St.Paul, MN

14h•Remote

About The Position

ActivStyle is seeking compassionate, detail-oriented individuals to join our team as Insurance Verification Specialists. In this role, you will play a critical part in ensuring patients receive essential home-delivered medical supplies by obtaining, analyzing, and verifying referral and insurance information accurately and efficiently. You will work closely with patients, healthcare providers, and insurance companies to support timely billing, clean claim processing, and seamless product delivery. This position is ideal for individuals passionate about helping others, solving problems, and thriving in a supportive, mission-driven environment.

Requirements

High School Diploma or equivalent.
One (1) year of work-related experience in healthcare administrative, financial, or insurance customer services, claims, billing, call center, or management regardless of industry.
Exact job experience is considered any of the above tasks in a Medicare-certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.
Excellent customer service skills.
Analytical and problem-solving skills with attention to detail.
Strong decision-making abilities.
Excellent ability to communicate both verbally and in writing.
Ability to prioritize and manage multiple tasks.
Proficient computer skills and knowledge of Microsoft Office.
Solid ability to learn new technologies and possess the technical aptitude required to understand data flow through systems and system interaction.
Work well independently and as part of a team.
Ability to adapt and remain flexible in a rapidly changing environment; be patient, accountable, proactive, take initiative, and work effectively on a team.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.

Nice To Haves

General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.

Responsibilities

Develop and maintain working knowledge of current products and services offered by the company.
Review all required documentation to ensure accuracy.
Maintain extensive knowledge of different types of payer coverage and insurance policies.
Verify patient insurance coverage to ensure necessary procedures are covered by the individual's insurance accurately.
Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles.
Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required.
Resolve any issues with coverage and escalate complicated issues to a manager.
Complete accurate patient demographic and insurance entry into EMR databases.
Enter data accurately into EMR databases, including payer, authorization requirements, coverage limitations, and expiration dates as needed.
Spend extensive amounts of time on the phone or on payer websites with insurance companies.
Provide pertinent information regarding patient's coverage to relevant parties.
Navigate through multiple online EMR systems to obtain applicable documentation.
Communicate with Customer Service and Management on an ongoing basis regarding any noticed trends with insurance companies.
Verify insurance carriers are listed in the company's database system; if not, request that new carriers be entered.
Contact patients when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
Meet quality assurance requirements and other key performance metrics.
Pay attention to detail and maintain great organizational skills.
Remain flexible with work tasks and hours of operation.
Utilize company-provided tools to maintain quality, including Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (Medicare Provider Enrollment, Chain, and Ownership System), and "How-To" documents.
Assume on-call responsibilities during non-business hours in accordance with company policy.
Maintain patient confidentiality and function within HIPAA guidelines.
Complete assigned compliance training and other educational programs as required.
Participate in educational programs as required.
Perform other related duties as assigned.