Job Overview

The Insurance Verification Specialist is responsible for accurately verifying patient insurance eligibility and benefits, identifying referral and authorization requirements, obtaining required PCP referrals and prior authorizations, and ensuring all information is properly documented in ECW prior to the patient's scheduled service. The Specialist is expected to support a daily patient volume of approximately 30–40 patients per day while maintaining a high level of accuracy and preventing avoidable insurance denials, delays, and patient financial issues. 

Schedule: Eastern Time; Monday-Friday 7:30AM to 4:30 PM
Job Type: Full time, 40 hours a week

Responsibilities:

 A. Insurance Eligibility & Benefits Verification

Goal: Verify 100% of scheduled patients prior to their appointment. Responsibilities include:

• Verify active insurance coverage.

• Confirm effective and termination dates.

• Verify specialist benefits.

• Verify deductible, coinsurance, copay, and out-of-pocket requirements when applicable.

• Confirm in-network/out-of-network status.

• Identify plan-specific requirements.

• Document verification accurately in ECW. 

 B. HMO Referral Management 

Goal: Identify and obtain 100% of required PCP referrals before the patient's service. The Specialist must identify referral requirements for HMO plans, including but not limited to:

• Humana HMO – PCP referral required

• Aetna HMO – PCP referral required

• BCBS HMO – PCP referral required 

  Responsibilities include:

• Confirm whether a referral is required.

• Verify referral validity and dates.

• Confirm correct provider/specialty.

• Confirm the number of authorized visits when applicable.

• Obtain referral from PCP when required.

• Document referral information in ECW.

• Notify scheduling/clinical staff immediately when a referral cannot be obtained. 

 C. Prior Authorization – Diagnostic Testing

Goal: Obtain 100% of required authorizations before diagnostic testing is performed.

Responsibilities include:

• Determine whether authorization is required.

• Submit authorization requests timely.

• Provide required clinical documentation.

• Verify approved CPT codes and diagnosis codes.

• Verify number of approved units/services.

• Verify authorization effective and expiration dates.

• Confirm approved facility/provider when applicable.

• Document authorization information in ECW. 

 D. Authorization & Referral Accuracy

Goal: Maintain 95–100% accuracy, with a target of zero preventable authorization/referral errors. The Specialist is responsible for ensuring:

• Correct patient.

• Correct insurance plan.

• Correct CPT code.

• Correct diagnosis code.

• Correct provider.

• Correct facility/location.

• Correct authorization dates.

• Correct number of approved services/units.

• Correct referral information.

• Errors that result in preventable denials, rescheduling, patient complaints, or financial loss may negatively impact this KPI. 

 E. ECW Documentation

Goal: Maintain 100% complete and accurate documentation. All verification and authorization information should be documented in ECW, including:

• Date benefits were verified.

• Representative/reference number when applicable.

• Referral information.

• Authorization number.

• Approved CPT codes/services.

• Authorization dates.

• Approved units.

• Relevant notes or restrictions.

• Any communication with insurance or PCP offices. 

 F. Daily Productivity & Patient Volume

The practice typically sees approximately 30–40 patients per day.

Goal: Complete insurance verification and authorization work in a timely manner sufficient to support the daily patient volume. Performance should include:

• Working assigned verification queues daily.

• Completing upcoming appointments in advance.

• Prioritizing appointments requiring referrals or authorizations.

• Following up on pending authorizations.

• Avoiding last-minute insurance issues.

• Communicating outstanding issues promptly. 

 G. Communication & Teamwork

Goal: Communicate insurance issues promptly and professionally. Responsibilities include:

• Notify management of unresolved insurance issues.

• Communicate referral/authorization problems to scheduling and clinical staff.

• Respond to staff questions in a timely manner.

• Follow up with PCP offices and insurance companies.

• Maintain professional communication with patients, insurance representatives, and medical offices.

• Avoid preventable delays caused by lack of communication. 

 

Requirements:

• Minimum 4+ years of experience in Insurance Payment Verification or similar roles.
• Minimum 2+ years of experience directly handling US healthcare clients and medical billing processes.
• Direct experience in eClinicalWorks (eCW) for documentation, medical billing, payment posting, and account reconciliation.
• Professional English communication skills, both verbal and written.
• Previous experience in the medical field handling insurance verification, HMO referral requirements, Prior/Diagnostic Testing Authorization, ECW Documentation, billing protocols and payment structures.
• Precise numeric entry skills to eliminate posting errors and ensure accurate patient balances.
• Professional phone manner with a patient-focused approach.
• Ability to handle high-volume environments with composure while maintaining accuracy.

 

Independent Contractor Perks

• Permanent work from home
• Immediate hiring
• Health Insurance Coverage for eligible locations (for full-time roles only)

Note

• Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.