Position Summary The Insurance Verification Specialist is responsible for ensuring all patients scheduled have verified insurance coverage, completed benefit investigations, required authorizations, referrals, and funding assistance in place prior to the date of service. This role is critical in reducing claim denials, treatment delays, and financial risk to the practice while supporting a positive patient experience. The specialist works closely with providers, technicians, scheduling staff, and insurance carriers to ensure accurate and timely processing of all injection-related appointments.

Essential Duties and Responsibilities:

Schedule Preparation & Review

• Review clinic schedules beginning 14 clinic days prior to date of service.
• Complete benefit investigations (BI) at least 21 days prior to service.
• Identify all injection and laser procedure appointments.
• Review study appointments for potential injections, exams, and imaging requirements.
• Prepare and finalize injection schedules and drug forms for provider review and technician distribution. Insurance Verification
• Verify patient insurance eligibility for all patients.
• Identify inactive, incorrect, or incomplete insurance coverage and contact patients to obtain updated information.
• Document all verification activity accurately within the practice management system.
• Review eligibility summaries for copays, coverage details, and discrepancies. Benefit Investigations & Funding Assistance
• Complete and document benefit investigations for all applicable medications.
• Confirm drug coverage, patient financial responsibility, and prior authorization requirements.
• Ensure benefit investigations remain current within a 3-month timeframe.
• Assist patients with enrollment into copay assistance and funding programs when eligible. Authorizations & Referrals
• Verify authorization approvals, effective dates, end dates, insurance coverage, and drug codes.
• Enter and attach referrals and authorizations appropriately within the patient record.
• Ensure correct authorization is attached to each appointment prior to service. Patient Communication
• Contact patients regarding insurance discrepancies, missing information, funding applications, and financial responsibility.
• Make a minimum of three documented attempts when required information cannot be obtained.
• Place alerts and chart documentation when unresolved financial or authorization issues remain. Documentation & Compliance
• Maintain accurate and detailed documentation within Practice Plus and patient accounts.
• Ensure all workflows comply with payer guidelines and internal SOP requirements.
• Communicate unresolved issues promptly to providers and leadership.
• Assist in reducing claim denials and improving reimbursement accuracy. Qualifications
• High school diploma or equivalent required.
• Medical office, ophthalmology, retina, or insurance verification experience preferred.
• Knowledge of insurance eligibility, authorizations, referrals, and benefit investigations strongly preferred.
• Experience with Medicare, Medicaid, commercial insurance plans, and copay assistance programs preferred.
• Familiarity with Practice Plus, EHR systems, and payer portals preferred. Required Skills & Competencies
• Strong attention to detail and organizational skills.
• Ability to prioritize tasks and meet strict deadlines.
• Excellent communication and patient service skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Knowledge of medical terminology and insurance processes.
• Strong documentation and problem-solving abilities.
• Proficiency in Microsoft Office and electronic medical systems. Working Conditions
• Primarily office-based position.
• Frequent computer and telephone use.
• May require occasional schedule adjustments to support clinic operations. Performance Expectations
• Timely completion of schedule reviews and benefit investigations.
• Reduction in insurance denials and authorization delays.
• Accurate documentation and account management.
• Effective patient communication and follow-through.
• Compliance with practice SOPs and payer requirements.

Pay:

$21.00 - $23.00 per hour

Benefits:

401(k) Dental insurance Disability insurance Health insurance Life insurance Paid time off Vision insurance

Work Location:

In person