Insurance Verifications Representative

Job Description

Job Description

POSITION SUMMARY

The Insurance Verifier is responsible for reviewing scheduled procedures to determine insurance coverage, benefit eligibility, and patient financial responsibility. This role ensures all required pre-certifications and authorizations are obtained to support proper reimbursement. The Insurance Verifier communicates with patients regarding estimated out-of-pocket costs, collects or arranges point-of-service payments, and supports front-end revenue cycle processes. This position also provides support to registration and billing staff as needed to ensure efficient office operations and accurate financial documentation.

Task Expectations:

1. Insurance Verification & Financial Analysis

• Review all scheduled procedures for insurance coverage and reimbursement requirements
• Obtain and document insurance benefits, pre-certifications, and authorizations
• Determine patient financial responsibility and calculate self-pay estimates
• Document all insurance and financial information accurately in system forms or software

1. Patient Financial Communication

• Notify patients of insurance benefits, coverage details, and out-of-pocket costs
• Provide clear explanations of patient financial responsibility prior to services
• Assess patient ability to pay and coordinate with billing for payment arrangements when needed
• Discuss payment plans for self-pay or remaining balances as appropriate

1. Point-of-Service Collections

• Ensure collection of required patient payments at time of service is accurately documented
• Communicate point-of-service (POS) collection expectations to registration staff
• Monitor and support front-end cash collection processes
• Assist in meeting departmental collection goals

1. Registration & Administrative Support

• Support registration staff with verification and documentation needs
• Assist with general office duties including filing, phone coverage, and insurance follow-up calls
• Verify insurance information with carriers as needed
• Prepare and organize documentation for scheduled procedures

1. Communication & Coordination

• Contact patients via phone to provide insurance updates and financial estimates
• Communicate effectively with physician offices, insurance companies, and internal departments
• Serve as a resource for registration staff regarding insurance and financial questions
• Escalate complex billing or payment concerns to appropriate departments

1. Compliance & Documentation

• Maintain compliance with HIPAA and all facility policies and procedures
• Ensure accurate completion of MSP questionnaires for government-based insurance plans
• Document all required financial and insurance information accurately and timely
• Follow established protocols for release of information and financial communication

EDUCATION

• High school diploma required; post-secondary education preferred.

• Training performed on site until successfully trained and onboarded.

• Registration and or medical billing experience preferred