Insurance Verification Specialist

Caron Treatment Centers- Career•Wernersville, PA

About The Position

Caron Treatment Centers is hiring an Insurance Verification Specialist to complete insurance benefit verification for scheduled and prospective admissions and support informed financial planning before admission. The role validates coverage and eligibility, researches payer requirements, identifies authorization needs, calculates estimated patient financial responsibility, and documents outcomes in designated systems. The specialist provides accurate, timely information to Admissions, Intake, Utilization Management, Revenue Cycle, Financial Counselors, and patient financial services teams. The position also serves as a resource and escalation point for complex insurance verification and payer concerns. It requires professional, clear communication with patients, families, insurance representatives, referral sources, and internal departments, while maintaining a patient-centered service approach. The specialist manages a high-volume workload, meets productivity and turnaround standards, participates in team workflow activities, and assists with urgent and same-day admissions. Caron describes its workplace as supportive and collaborative, with opportunities to learn, grow, and build a meaningful career. The organization says its mission is to provide compassionate, evidence-based addiction and behavioral healthcare.

Requirements

High school diploma or GED.
Minimum one year of insurance verification, patient access, admissions, healthcare revenue cycle, or related healthcare experience.
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.
Ability to sit and use a telephone and computer for at least 85% of the workday.
Ability to verbally communicate for 85% of the workday.
Ability to type for 80% of the workday.

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 and serve as the primary escalation point for complex verification issues and payer-related concerns.
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.
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 in all interactions.
Prioritize workload based on admission volume, scheduled admissions, payer requirements, and urgent patient needs.
Support financial counseling processes by providing accurate insurance benefit information.
Collaborate with patient financial services teams to facilitate collection planning and financial arrangements.
Help ensure patients and families receive accurate information about expected financial obligations.