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Insurance Verification Coordinator
Career Insights for Eligibility Specialist
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Scorecard
Based on Florida data
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What they do
An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
$44,207 / year median in Florida
+17% projected growth
Job Description
Insurance Verification Specialist Position Summary The Insurance Verification Specialist is responsible for verifying patient insurance eligibility and benefits prior to scheduled appointments and procedures. This role ensures accurate coverage information is obtained, authorizations are identified when required, and patients and staff are informed of any financial responsibilities to support a smooth patient experience. Essential Duties and Responsibilities Verify patient insurance eligibility, benefits, and coverage prior to appointments and procedures. Determine patient financial responsibility, including copayments, deductibles, coinsurance, and out-of-pocket costs. Obtain and document insurance verification details accurately in the electronic medical record (EMR) and practice management system. Identify services requiring prior authorization and coordinate with the appropriate department to obtain approvals. Contact insurance companies to clarify benefits, coverage limitations, and authorization requirements. Communicate insurance-related information to patients, providers, and office staff. Resolve insurance discrepancies and update patient demographic and insurance information as needed. Maintain compliance with HIPAA and all applicable federal, state, and company policies. Assist with other administrative duties as assigned. Qualifications High school diploma or equivalent required. Minimum of 1 year of insurance verification, medical billing, or medical office experience preferred. Knowledge of commercial insurance, Medicare, Medicaid, and workers' compensation preferred. Experience with EMR and practice management software. Strong attention to detail and organizational skills. Excellent verbal and written communication skills. Ability to manage multiple priorities in a fast-paced healthcare environment. Proficiency in Microsoft Office and standard computer applications. Physical Requirements Prolonged periods of sitting and working on a computer. Ability to communicate effectively by phone and email. Occasionally lift up to 15 pounds. Benefits Competitive pay Medical, dental, and vision insurance Paid time off Paid holidays 401(k) with company match Opportunities for professional growth and development