Open Opportunities

The Insurance Verification & Referral Specialist is key to department success because they focus on ensuring patient health care benefits cover required procedures. The patient experiences an unnecessary financial burden when the insurance is incorrectly applied. The specialist is responsible for verifying patient insurance coverage and securing referrals from the insurance payers for required treatments. The position aims to maximize system efficiencies, increase accuracy, and improve reimbursement outcomes. This is a full-time position. The hours are Monday-Friday 8am-4:30pm with a 30-minute lunch.

• Process new intakes/referrals in the workflow queue. Enter insurance information (policy number, group number, primary care provider) into the EHR or practice management system
• Verify patient insurance eligibility before medical services are rendered through insurance companies or online portals (e.g., commercial, Veterans Association, Medicare, Medicaid)
• Check insurance plan details (co-pays, deductibles, co-insurance, out-of-pocket maximums, restrictions)
• Inform patients and healthcare providers of any limitations, pre-existing condition clauses, and pre-authorization or referral requirements. Explain insurance benefits and out-of-pocket costs to patients
• Assist patients in understanding insurance policies and resolving issues with claims, coverage, or referrals
• Communicate with other departments regarding eligibility and referral authorizations
• Manage complex cases involving multiple insurance plans, out-of-network providers, or coverage disputes
• Address insurance denials, submitting necessary documentation to resolve the issue
• Collaborate with providers and insurance companies to appeal denied referrals or authorization requests
• Regularly update patient insurance information for changes in coverage or policy status
• Coordinate with billing and coding teams to align insurance verifications and authorizations with submitted claims
• Create and maintain reports on insurance verifications, referrals, and authorizations for internal use or compliance
• Monitor the referral process for efficiency and identify areas for improvement

Required Qualifications

• High School diploma or equivalent
• One year of experience with exposure to insurance eligibility
• One year experience with medical insurance terminology, CPT, ICD coding structures, and billing forms
• Knowledge of high-functioning EHR, billing systems, and applications (iKnowMed, Lynx, Centricity, Epic, etc.)
• Ability to communicate clearly verbally and in writing
• Ability to communicate with multiple levels within internal and external organizations with ease and effectiveness (e.g., physicians, APPs, clinical, management, and support staff)
• Ability to analyze details logically and accurately
• Demonstrated communication skills
• Excellent PC operating skills and use of MS Office

Preferred Qualifications

• Associate’s degree in applicable field
• Experience with Oncology billing
• Understanding of Unlimited Systems Revenue Cycle Software

A successful Insurance Verification and Referral Specialist will…

• Enjoy interacting with various people, making the best of each interaction
• Practice the balance of cooperation and urgency daily
• Develop and unite partnerships with internal and external associates to accomplish better systems and outcomes
• Create and maintain regular and reliable measures of team performance and success
• Possess extraordinary critical thinking and organizational skills
• Self-starter who can influence positive change
• Possess unrelenting determination
• Thrive in team environments