Verification of Benefits Specialist

Job Summary: The Verification of Benefits Specialist is responsible for verifying and confirming the benefits and coverage provided by a patient’s insurance plan. This includes ensuring that the services a patient is scheduled to receive are covered under their plan and determining the necessary information to process claims efficiently.  

Key Responsibilities:  

• Verify patient insurance information with insurance companies or other third-party payers.  

• Confirm the patient’s benefits, including co-payments, deductibles, and coverage limits.  

• Communicate with patients, providers, and insurance companies to clarify and confirm insurance coverage details.  

• Review patient insurance policies to determine what services are covered.  

• Obtain prior authorizations and referrals for specific procedures as required by insurance providers.  

• Assist patients in understanding their insurance coverage and payment responsibilities.  

• Maintain accurate and up-to-date patient insurance records in the database.  

• Work closely with the billing and coding teams to ensure smooth claim processing.  

• Resolve discrepancies or issues with insurance coverage by working directly with insurers or patients.  

• Prepare and submit accurate benefit verification reports.  

• Follow up on outstanding benefit verification issues to ensure timely resolution.  

• Ensure compliance with all healthcare regulations and insurance provider policies.  

• High school diploma or equivalent; some positions may require an associate or bachelor’s degree.  

• Previous experience in medical insurance verification, billing, or coding is preferred.  

• Knowledge of insurance terminology and procedures.  

• Familiarity with medical billing software and Electronic Health Record (EHR) systems.  

• Strong communication skills, both written and verbal.  

• Attention to detail and strong organizational skills.  

• Ability to handle sensitive patient information confidentially.  

Skills:  

• Proficient in Microsoft Office Suite.  

• Knowledge of insurance verification platforms and databases.  

• Ability to manage multiple tasks simultaneously in a fast-paced environment.  

• Problem-solving and analytical skills to resolve insurance issues. Certifications: 

• Certification in utilization management is preferred; licensure in nursing or social services is a plus.