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.
Overland Park, KS Job Details Full-time 1 day ago Qualifications Customer communication High school diploma or GED Full Job Description KU MedWest Ambulatory Surgery Center, LLC Insurance Verification Representative
SUMMARY DESCRIPTION
The Insurance Verification Representative is responsible for verifying patient insurance coverage, benefits, and eligibility prior to scheduled surgical procedures. This role ensures accurate and timely verification of benefits, identification of patient financial responsibility, and communication with patients, physicians' offices, and payers to support a seamless patient experience and optimize revenue cycle performance. This is a fast-paced environment that requires attention to detail, accountability, teamwork, and professional behavior while supporting high-quality patient care.
RESPONSIBILITIES
Verify patient insurance eligibility, benefits, and authorization requirements prior to scheduled procedures Confirm coverage details including deductibles, co-pays, co-insurance, out-of-pocket maximums, and plan limitations Obtain and validate pre-authorizations and referrals as required by payer guidelines Communicate financial responsibility clearly to patients, including estimated out-of-pocket costs Work closely with physician offices, schedulers, and the Business Office to ensure all required information is obtained prior to service Identify and resolve discrepancies in insurance information, eligibility, or authorization requirements Maintain accurate and detailed documentation of all verification activities in the system Ensure compliance with payer guidelines, regulatory requirements, and organizational policies Support front-end revenue cycle processes to minimize denials and delays in reimbursement Collaborate with billing, coding, and accounts receivable teams to ensure clean claim submission Provide excellent customer service to patients and internal stakeholders KNOWLEDGE, SKILLS, and
ABILITIES
Strong understanding of health insurance plans (HMO, PPO, EPO, POS, Worker's Compensation, Self-Pay, and Third-Party payers) Knowledge of insurance verification, authorization processes, and medical terminology Strong attention to detail with a high level of accuracy Ability to communicate effectively with patients, payers, and internal teams Ability to work independently and prioritize tasks in a fast-paced environment Strong problem-solving and critical thinking skills Ability to maintain confidentiality and handle sensitive patient information Self-motivated with the ability to contribute to a collaborative team environment
REQUIREMENTS
High School diploma or equivalent
Preferred:
1-3 years of experience in insurance verification, medical front-end revenue cycle, or healthcare administration Experience with electronic medical records (EMR) and/or billing systems Basic knowledge of medical terminology and insurance processes Strong verbal and written communication skills Customer service and patient-focused mindset Ability to multi-task and meet deadlines
