Verification Specialist

Allegiance Mobile Health•Georgetown, TX

3d•Remote

About The Position

This position is responsible for the daily processing of patient and payer eligibility verification for ground ambulance transports, including Medicare, Medicaid, managed care, and third-party commercial insurance. The role verifies coverage for both emergency and non-emergency ambulance transports, confirms medical necessity documentation requirements, and identifies payer-specific prior authorization needs for scheduled/non-emergency transports (e.g., dialysis, discharge, and facility-to-facility runs). The daily productivity and quality standard is a minimum of 85 verifications per day utilizing web-based payer portals, clearinghouse tools (e.g., Waystar), and direct payer contact, while maintaining accuracy and completeness of eligibility data within the billing system (LOGIS).

Requirements

Ability to read, analyze, and interpret insurance plans and ambulance-specific coverage policies.
Working knowledge of Medicare, Medicaid, and commercial insurance benefits as they apply to ground ambulance transport.
Proficient in online/web-based payer portal verification as well as verbal (phone-based) verification.
Must have accurate, high-level data entry skills with a continuous quality focus.
Must have excellent phone and customer service skills.
Must be detail oriented with excellent organizational and problem-solving skills.
Experience in MS Office and general computer skills.
High School Diploma required
Minimum of nine (9) months of experience in a medical office, EMS, or ambulance billing setting

Nice To Haves

Familiarity with ambulance billing terminology, including HCPCS transport codes, loaded mileage, and origin/destination modifiers, is preferred.
Experience with LOGIS, Waystar, or similar EMS billing/clearinghouse platforms is a plus.
Associate's Degree preferred.
prior ambulance/EMS eligibility verification experience preferred.

Responsibilities

Meets and/or exceeds the daily quota of Medicare, Medicaid, and commercial insurance verifications for ground ambulance transports.
Verifies patient eligibility and benefits for both emergency (911) and non-emergency (scheduled) ambulance transports prior to or immediately following dispatch.
Gathers all pertinent demographic, insurance, and guarantor information from the verification source at the initial encounter or dispatch record.
Accurately documents verification results, authorization numbers, and payer notes in LOGIS to support clean claim submission.
Takes necessary steps to obtain missing demographic or insurance information, including faxing facilities, contacting dispatch, and telephone communication with patients or family members when necessary.
Follows HIPAA guidelines regarding the handling and dissemination of patient information throughout the verification process.
Coordinates with billing, collections, and dispatch staff to resolve eligibility discrepancies and reduce downstream denials.
Adheres to company policies and procedures.
Regular attendance is an essential function of the position.
Other duties as assigned.