Position Summary The Insurance Specialist is responsible for verifying patient insurance benefits, obtaining authorizations, accurately determining patient financial responsibility, and supporting the clinic's billing and revenue-cycle operations. This position works closely with patients, insurance companies, physicians, and front-office and billing staff to ensure ophthalmology services are properly authorized, documented, and reimbursed. The ideal candidate is detail-oriented, organized, knowledgeable about health insurance plans, and comfortable working in a fast-paced medical office environment. Key Responsibilities Verify patient insurance eligibility and benefits prior to appointments and procedures. Review coverage for ophthalmology services, including office visits, diagnostic testing, imaging, injections, surgeries, and other procedures. Obtain and track insurance authorizations and referrals when required. Identify patient copays, coinsurance, deductibles, and other financial responsibilities. Communicate insurance benefits and estimated out-of-pocket costs clearly and professionally to patients. Contact insurance companies regarding coverage, benefits, claim requirements, authorizations, and payment issues. Review medical and vision insurance plans and determine appropriate coverage for services. Work with clinical staff to obtain necessary documentation for authorizations and claims. Assist with resolving denied, rejected, or underpaid claims by researching insurance requirements and providing necessary information. Maintain accurate records of authorizations, referrals, insurance communications, and follow-up activities. Monitor pending authorizations and follow up with insurance carriers in a timely manner. Coordinate with billing and front-office teams to resolve insurance-related patient account issues. Stay current on insurance policies, payer requirements, Medicare guidelines, and changes affecting ophthalmology services. Protect patient privacy and maintain compliance with HIPAA and clinic policies. Provide excellent customer service while handling sensitive financial and insurance information. Qualifications High school diploma or equivalent required. Previous experience in medical insurance verification, prior authorization, medical billing, or healthcare revenue cycle preferred. Experience in an ophthalmology, optometry, or other specialty medical practice is preferred. Knowledge of Medicare, Medicaid, commercial insurance, HMOs, PPOs, and vision plans. Familiarity with CPT, ICD-10, and insurance terminology. Strong attention to detail and ability to identify discrepancies in insurance information. Excellent communication and customer-service skills. Ability to work independently while collaborating effectively with a healthcare team. Proficiency with computers and practice management systems. Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment. Preferred Skills Ophthalmology insurance and authorization experience. Experience with surgical authorizations and specialty medications/injections. Familiarity with Medicare and Medicare Advantage plans. Experience working with major commercial insurance carriers. Knowledge of medical versus vision insurance coverage. Experience appealing or researching denied claims. Work Environment This position is primarily performed in a professional ophthalmology clinic environment. The Insurance Specialist will interact regularly with patients, physicians, clinical staff, insurance representatives, and billing personnel. Success in This Role A successful Insurance Specialist is accurate, proactive, organized, patient-focused, and persistent . They understand that timely insurance verification and authorization directly affect both the patient experience and the financial health of the practice.

Pay:

$17.00 - $20.00 per hour Expected hours: 40.0 per week

Benefits:

401(k) Dental insurance Disability insurance Employee discount Health insurance Life insurance Paid time off Retirement plan

Work Location:

In person