Insurance Verification Specialist

Caron Treatment Centers•Wernersville, PA

18h

About The Position

The Insurance Verification Specialist completes insurance verification for scheduled and prospective admissions at Caron Treatment Centers. The role validates eligibility, coverage details, behavioral health and substance use disorder benefits, network status, authorization requirements, coordination of benefits, and payer-specific requirements. It also calculates and communicates estimated patient financial responsibility and supports financial planning and arrangements before admission. The specialist provides timely, accurate benefit information to Admissions, Intake, Utilization Management, Revenue Cycle, Financial Counselors, and patient financial services teams. The role documents verification outcomes, maintains productivity and turnaround standards, handles urgent and same-day requests, and serves as a resource and escalation point for complex insurance matters. The position requires clear, professional, patient-centered communication with patients, families, payers, referral sources, and internal teams. The physical requirements include sitting and using a telephone and computer for at least 85% of the workday, verbally communicating for 85%, and typing for 80%. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

High school diploma or GED.
At least one year of insurance verification, patient access, admissions, healthcare revenue cycle, or related healthcare experience.
Knowledge of ASAM level-of-placement criteria and medical necessity.
Working knowledge of commercial insurance and managed care plans.
Proficiency with Microsoft Office applications.
Strong understanding of insurance benefits and eligibility verification.
Excellent verbal and written communication skills.
Critical-thinking and problem-solving abilities.
Strong organizational and time-management skills.
Ability to work independently while managing high-volume workloads.
Attention to detail and commitment to accuracy.
Proficiency with payer portals and electronic medical records.
Ability to collaborate effectively across departments.
Strong customer service orientation.

Responsibilities

Complete comprehensive insurance verification for scheduled and prospective admissions.
Validate eligibility, effective dates, deductibles, out-of-pocket maximums, coinsurance, copayments, lifetime benefits, and policy limitations.
Verify behavioral health and substance use disorder benefits.
Identify network status, single case agreement requirements, and out-of-network benefit structures.
Confirm authorization requirements for all levels of care.
Research coordination of benefits, secondary insurance coverage, and payer-specific requirements.
Escalate complex insurance issues when appropriate.
Calculate and communicate estimated patient financial responsibility.
Collaborate with Financial Counselors to support informed financial planning before admission.
Provide accurate and timely benefit information to Admissions, Intake, Utilization Management, and Revenue Cycle teams.
Document insurance verification outcomes in designated systems.
Maintain productivity standards and established turnaround times.
Participate in daily huddles, team meetings, and workflow management activities.
Assist with urgent admissions and same-day verification requests.
Serve as a primary resource for insurance benefit questions and the primary escalation point for complex verification issues and payer-related concerns.
Communicate professionally with patients, families, insurance representatives, referral sources, and internal departments.
Explain benefits, financial obligations, and authorization requirements clearly.
Maintain a patient-centered and service-oriented approach.
Prioritize workload based on admission volume, scheduled admissions, payer requirements, and urgent patient needs.
Support financial counseling by providing accurate insurance benefit information.
Collaborate with patient financial services teams to facilitate collection planning and financial arrangements.
Ensure patients and families receive accurate information about expected financial obligations.