Verify patient insurance coverage and eligibility prior to scheduled procedures.
Obtain necessary pre-authorizations and pre-certifications from insurance companies.
Confirm patient benefits including deductible, co-pay, co-insurance, and out-of-pocket amounts.
Communicate financial responsibility to patients and collect or arrange for payments as needed.
Coordinate with schedulers, clinical staff, and billing department to ensure accurate documentation and timely submission.
Accurately input insurance data into the electronic medical records (EMR) system.
Contact patients, insurance companies, and referring offices as needed for clarification or follow-up.
Identify and resolve any insurance-related discrepancies prior to the date of service.
Maintain thorough documentation of verification and authorization processes.
Stay up to date on insurance requirements and changes in coverage policies.
High school diploma or GED required.
Minimum of 1–2 years of experience in insurance verification or medical billing, preferably in a surgical or outpatient setting.
Knowledge of major insurance carriers, including Medicare, Medicaid, and commercial plans.
Strong understanding of medical terminology, CPT, and ICD-10 codes.
Excellent communication and customer service skills.
Ability to multitask and prioritize in a fast-paced environment.
Proficiency with EMR and scheduling systems (experience with systems such as NextGen, Epic, or similar is a plus).
Bilingual (English/Spanish) preferred, but not required.
