Benefits Verification Specialist

Assists with processing, insurance verification and authorization, revenue cycle management, compliance and documentation, as well as customer service and issue resolution. Provides support in ensuring accurate billing, efficient revenue flow, and compliance with regulations.

What you will do

• Gathers necessary information to verify critical member benefits insurance coverage, such as policy numbers, group numbers, and demographic details.
• Reviews insurance plans and policies to determine the extent of coverage for different medical procedures, treatments, medications, or services.
• Contacts insurance providers to verify eligibility, coverage limits, pre-authorization requirements, and any specific benefits relevant to member services or treatments.
• Explains the verification process, provides updates on the status of benefits verification, and addresses any questions or concerns related to coverage or financial responsibility.
• Maintains accurate and detailed records of insurance verification activities, including documenting conversations, collecting insurance information, and updating patient or member profiles.
• Communicates any authorization requirements, coverage limitations, or pre-certification processes to ensure smooth billing and claims processing.
• Investigates and resolves any challenges or conflicts that may arise during the verification process, working closely with insurance providers, patients, or members to find resolutions.
• Proposes process enhancements, automation, or system improvements to streamline operations and enhance the overall effectiveness of benefits verification activities.
• Responds to member inquiries and concerns promptly, empathetically, and professionally, ensuring a positive customer experience.

For this role you will need Minimum Requirements

• Less than 1 year work experience

Preferred Qualifications

• Certified Professional, Life and Health Insurance Program (CPLHI) preferred.
• Certified Employee Benefit Specialist (CEBS) preferred.

Education

• High School Diploma