Insurance Verification Specialist

RCM Insurance Verification Specialist performs clerical functions for patient billing, including verification of insurance information and resolution of problems to ensure a clean billing process. The role follows up on accounts that require further evaluation and works collaboratively with the team.

Essential Functions

• Maintain patient demographic information and verify, enter, or update insurance information for new and existing patients, including copays and deductibles.
• Verify insurance eligibility for upcoming appointments using EMR systems, online websites, or direct carrier contact.
• Explain financial responsibilities to patients.
• Coordinate with staff and management regarding scheduling errors and update the error spreadsheet daily.
• Enter insurance effective dates and/or authorization details.
• Participate in the development of organization procedures and updates to forms and manuals.
• Answer questions from patients, clerical staff, and insurance companies.
• Work with reception to help ensure clean billing.
• Perform miscellaneous job-related duties as assigned.
• Maintain strict confidentiality and adhere to all HIPAA guidelines and regulations.
• Assist in developing and communicating SOPs for key areas to improve accuracy and understanding of processes.

Process Responsibilities

• Check assigned locations daily and confirm eligibility, copay, and outstanding balance for every scheduled patient.
• Enter and update carrier details in the insurance section of the patient account, including plan name, effective dates, co-pays, and deductibles.
• Flag and address potential errors and log them in the Eligibility Error Spreadsheet.
• Add copay and outstanding collection notes in appointment details for PSRs to review during check-in.
• Document issues related to portal downtime or insurance errors in appointment details for PSRs.
• Maintain verification management at least two days ahead of schedule.
• Attempt to collect outstanding balances and work with RCM management as needed.