Insurance Verification Specialist
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Job Description
Insurance Verification Specialist handling verification and management of patient insurance benefits. Collaborating with healthcare providers to ensure correct insurance information for quality patient care.
Responsibilities:
- Run partial insurance verification immediately upon referral intake
- Confirm in-network status and identify credentialed providers by department
- Flag inactive, incorrect, or out-of-network insurance before patient contact
- Complete full benefits verification once service type is confirmed
- Obtain co-pay and deductible information by service type
- Rework incorrect or missing insurance information — approx. 10–20% of referrals
- Maintain and update provider credentialing database by insurance
- Update patient records with all verified benefits information
Requirements:
- 1+ year experience in medical insurance verification or revenue cycle management
- Knowledge of behavioral health benefits — mental health billing differs from medical
- Familiarity with EOBs, co-pays, deductibles, and in/out-of-network rules
- Detail-oriented with strong data entry accuracy
- HIPAA knowledge and compliance awareness
- Experience specifically in behavioral health or psychiatric practice billing
- Certified Medical Reimbursement Specialist (CMRS) or similar credential
- Familiarity with South Carolina Medicaid and major commercial plans
- Experience with multi-provider credentialing databases
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