Insurance Verification Specialist

JOHNSON HEALTH CENTER•Madison Heights, VA

2d•Hybrid

About The Position

The Insurance Verification Specialist works as part of the administrative team and is responsible for verifying patient insurance coverage and obtaining prior authorizations for services. This role ensures accurate and timely processing to support patient access to care and proper reimbursement for services rendered.

Requirements

High School diploma or equivalent.
Previous billing experience required.
Must be self-motivated with well-developed organizational skills and computer experience, including, but not limited to, Word, Excel, and database functions.
Must possess strong communication skills; works well with external organizations and employees.

Responsibilities

Verify patient insurance eligibility, benefits, and coverage prior to scheduled services.
Verify patient eligibility status for reduced fee if applicable.
Document in patient chart missing information needed.
Obtain and track prior authorizations for medical services and procedures.
Inform patients and/or Patient Assistance Specialists of insurance coverage, authorization status, and potential financial responsibility when appropriate.
Maintain accurate and up-to-date records in the electronic health record (EHR) and practice management system.
Monitor authorization requests to ensure timely approval and prevent delays in patient care.
Follow up on pending, denied, or incomplete authorizations and take appropriate action.
Assist in resolving claim denials related to eligibility or authorization issues.
Collaborate with billing, front desk, and clinical teams to support efficient revenue cycle operations.
Ensure compliance with organizational policies, payer regulations, and applicable federal/state guidelines.
Stay current on payer guidelines, insurance policies, and authorization requirements.
Support process improvement efforts to enhance workflow efficiency and reduce authorization delays.
Ensure confidential information gained through job performance is kept confidential.
Must demonstrate good internal and external customer service skills.
Follows supervisor's instructions.
Physical attendance is an essential element of the job and necessary to perform the essential functions of the Insurance Verification Specialist.
Assists other department members as needed.
Performs other duties as assigned.
Staff will abide by the Code of conduct as documented in the Corporate Compliance Manual.
Must demonstrate a personal and professional commitment to Johnson Health Center and its mission.
Treats all patients and staff with dignity and respect, mindful of the cultural differences of the diverse population we serve.
Management may modify, add or remove any job functions as necessary, or as changing organizational needs require.