Insurance Verification Specialist

The Insurance Verification Specialist is responsible for ensuring accurate, timely verification of patient insurance benefits prior to dermatology appointments and procedures. This role supports both medical and surgical dermatology services by confirming coverage, identifying authorization requirements, communicating patient financial responsibility, and preventing claim denials. The specialist works closely with front desk staff, medical assistants, and the billing department to maintain smooth patient flow and a positive patient experience. Key Responsibilities Verify insurance eligibility and benefits for all scheduled patients, including medical dermatology, surgical dermatology, and cosmetic appointments. Confirm coverage details such as deductibles, co‑pays, co‑insurance, out‑of‑pocket status, and specialist visit requirements. Identify prior authorization requirements for procedures (e.g., biopsies, excisions, Mohs surgery). Obtain prior authorizations when required and document approval numbers, effective dates, and limitations. Communicate patient financial responsibility clearly and professionally before the date of service. Review and update insurance information in the practice management system with accuracy. Contact insurance carriers via portals and phone to resolve discrepancies or unclear coverage details. Flag high‑risk or non‑covered services and notify clinical and front desk teams. Collaborate with billing to prevent claim denials and ensure accurate claim submission. Maintain confidentiality and compliance with HIPAA and all payer regulations. Provide excellent customer service to patients who have questions about their insurance benefits. Qualifications Insurance verification or medical billing experience, preferably in dermatology or a specialty practice, preferred. Strong understanding of commercial insurance, Medicare, Medicaid, and managed care plans preferred. Experience with EMR and insurance verification portals such as Navinet, DMAP and Availity preferred. Excellent communication, attention to detail, and problem‑solving skills. Ability to work independently and manage time efficiently in a fast‑paced environment. About SunWise Family Dermatology & Surgery, LLC Located in Delaware, SunWise Family Dermatology & Surgery, LLC, offers comprehensive and honest dermatology services to patients of all ages. The team at SunWise Family Dermatology & Surgery work by the motto "Our Family Taking Care of Your Family," making sure that their patients receive the best possible care.