Insurance Verification/Eligibility Specialist

EYE SPECIALISTS OF MID FLORIDA PA•Winter Haven, FL

14h•Onsite

About The Position

The Insurance Verification Specialist accurately and promptly verifies patient insurance eligibility, coverage, benefits, and authorization requirements before services are rendered. The role supports the revenue cycle by ensuring insurance information is complete, current, properly documented, and available to facilitate accurate billing and timely claims submission. The specialist researches and confirms insurance information through payer websites, electronic systems, telephone communication, and other approved resources. They identify coverage limitations, discrepancies, inactive coverage, missing information, coordination of benefits issues, and other insurance-related concerns, then communicate findings to appropriate departments for resolution. Working closely with Scheduling, Patient Care, Billing, patients, providers, and other departments, the specialist helps maintain accurate insurance information throughout the patient experience. The role requires attention to detail, knowledge of insurance terminology and payer requirements, effective communication, and the ability to manage multiple priorities in a fast-paced healthcare environment while maintaining accuracy and confidentiality. The position must comply with HIPAA, applicable federal and state requirements, and ESMF policies, procedures, and departmental standards.

Requirements

High school diploma or equivalent required.
Knowledge of health insurance eligibility, benefits, coverage, and payer requirements.
Strong attention to detail and accuracy when reviewing and entering information.
Ability to research, interpret, and document insurance information.
Ability to identify discrepancies and resolve or appropriately escalate insurance-related issues.
Excellent verbal and written communication skills.
Strong organizational and time-management skills.
Ability to prioritize and manage multiple tasks in a fast-paced environment.
Ability to work independently while contributing effectively to a team.
Ability to maintain accuracy and professionalism under pressure.
Proficient computer skills and ability to learn and use multiple software applications and electronic systems.
Ability to maintain strict confidentiality of patient and company information.
Professionalism and effective interpersonal skills when communicating with patients, team members, insurance representatives, and other departments.
Ability to sit for extended periods while performing computer- and telephone-based work; stand, walk, bend, reach, and perform routine office activities as needed.
Frequent use of a computer, keyboard, telephone, and other standard office equipment.
Ability to communicate effectively in person and by telephone.
Ability to see clearly at close and intermediate distances for computer work and document review.
Ability to work in a typical office environment with moderate noise levels.

Nice To Haves

One year of insurance verification experience preferred.
One year of medical billing or healthcare revenue cycle experience preferred.
Previous experience in a medical office, healthcare, insurance, or revenue cycle environment preferred.
Experience working with insurance payer websites and electronic verification systems preferred.
Knowledge of commercial and government insurance plans preferred.
Ophthalmology or other specialty healthcare experience preferred.
Valid Florida driver’s license required; travel to satellite locations may be needed for work assignments.

Responsibilities

Verify patient eligibility, insurance coverage, benefits, effective dates, deductibles, copayments, coinsurance, limitations, exclusions, and other applicable payer requirements.
Confirm patient demographic and insurance information and update systems as necessary.
Obtain and document insurance information using payer websites, electronic systems, telephone calls, and other approved resources.
Identify inactive coverage, discrepancies, missing information, coordination of benefits issues, and other insurance concerns, and communicate them to the appropriate department for resolution.
Review insurance requirements for referrals, authorizations, precertifications, and other payer-specific requirements.
Enter and maintain accurate insurance and patient information in applicable systems and databases.
Process insurance verification requests and address verification rejections or discrepancies in a timely manner.
Review and maintain documentation in accordance with departmental procedures and payer requirements.
Research payer policies, benefits, and coverage requirements to support accurate patient and insurance information.
Communicate insurance verification findings clearly and professionally to patients, providers, and internal departments as appropriate.
Coordinate with Scheduling, Patient Care, Billing, and other departments to ensure accurate insurance information is available for timely claims processing.
Assist in identifying and resolving insurance-related issues that may delay billing, claims submission, reimbursement, or collection.
Maintain accurate and organized records of insurance verification activities and related documentation.
Protect the confidentiality and security of patient, insurance, financial, and business information in accordance with HIPAA and ESMF policies and procedures.
Provide feedback and information to assist management with developing and improving departmental procedures related to insurance verification.
Maintain knowledge of payer requirements, insurance policies, and changes affecting eligibility, benefits, verification, and reimbursement.
Meet established departmental productivity, quality, accuracy, and turnaround-time expectations.
Perform other duties and responsibilities as assigned by management.