Insurance Verification Specialist

FamilyWell

22d • Remote

About The Position

FamilyWell Health is on a mission to transform women’s mental health across the reproductive life-span (fertility → perinatal → menopause) by embedding evidence-based, insurance-covered care into OB/GYN practices and health systems. FamilyWell Health. As part of the RCM/Operations team, the Prior Authorization Specialist will play a key role in ensuring that care is authorized, reimbursed, and seamlessly delivered, reducing friction for patients and providers alike.

Requirements

• High school diploma or GED required; Associate’s or Bachelor’s degree in health administration, business, healthcare management or related field preferred.
• Minimum 2-3 years of experience in healthcare provider services, prior authorization, utilization management, provider access or RCM in a multi-payer environment.
• Strong working knowledge of insurance eligibility, authorizations, CPT/HCPCS codes, payer policies (especially behavioral health/CoCM), and EMR/authorization workflow systems.
• Experience with payer types including Medicaid MCOs, FFS, Medicare Advantage and commercial insurers.
• Excellent organizational, time-management and documentation skills; ability to track multiple authorization requests in parallel and follow through to completion.
• Strong communication skills – able to interact with payers, providers, internal teams and patients in a clear and professional manner.
• Detail-oriented and proactive. Able to identify missing documentation or authorizations before service delivery to prevent denials.
• Analytical mindset – comfortable reviewing authorization/denial data, identifying trends, and recommending process improvements.
• Ability to translate technical payer policy/authorization requirements into clear internal SOPs and patient-facing communications (consistent with your preference for ready-to-use templates).
• Comfort working in a remote environment and collaborating across teams (credentialing, billing, care management, operations).

Nice To Haves

• Experience working in a behavioral health or women’s health setting is a strong plus.

Responsibilities

• Verify patient insurance eligibility and behavioral health benefits for all new and existing patients.
• Confirm coverage for therapy, psychiatry, coaching (when applicable), and Collaborative Care (CoCM) codes 99492–99494.
• Determine plan type (commercial, Medicaid/MCO, Medicare/Advantage, HMO/PPO) and in/out-of-network status.
• Identify high-deductible plans and flag accounts requiring patient cost-share counseling.
• Verify secondary insurance when applicable.
• Enter accurate benefit details in Healthie, including deductibles, copays, coinsurance, authorization notes, and portal findings.
• Ensure all benefit information is complete, consistent, and documented prior to the patient's appointment.
• Maintain internal benefit verification logs and update payer-specific notes as needed.
• Communicate directly with patients when coverage issues arise, such as inactive plans or high cost-share amounts.
• Collaborate with billing, credentialing, and patient collections to ensure a smooth revenue cycle and minimize denials.
• Work closely with OB/GYN partner clinics to confirm referral diagnoses, dates of service, and PA requirements.
• Escalate benefit discrepancies, payer issues, or unclear coverage to the RCM leadership team.
• Maintain a high level of accuracy and thoroughness in all insurance verifications.
• Stay current on payer updates, plan changes, and multi-state coverage nuances.
• Protect patient information in compliance with HIPAA and FamilyWell policies.
• Support ongoing process improvements and participate in RCM team huddles as needed.

Benefits

• Be part of a mission-driven organization tackling women’s mental health and making a meaningful difference across fertility to menopause.
• Collaborate with a dynamic, embedded team model (care managers, therapists, psychiatrists, OB/GYN partners) that values operational excellence and patient experience.
• Opportunity to build and improve processes, documentation, and workflows—leveraging your strengths in SOP creation, training and high-impact coordination.
• Growth opportunity as the organization expands services, payer panels, and geographies.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED