Insurance Verifications Specialist

WHAT WE DO: ACME builds lasting relationships and provides a standard of excellence. Our culture is grounded in honor, integrity, family, and a strong commitment to inspiring hope. ACME is a management service organization that supports a network of healthcare entities across multiple states, delivering managerial and administrative services. These services include corporate administration, recruiting, revenue cycle management, scheduling, accounting, and case management. ACME tailors support services around each organization's needs. Together, we're creating more than operational success—we're building a community of care.

JOB DESCRIPTION: The Insurance and Verification Specialist is responsible for verifying patient insurance coverage, determining benefits and eligibility, and securing prior authorizations prior to scheduled services. This role plays a vital part in ensuring accurate patient financial estimates and supporting timely reimbursement. The ideal candidate is detail-oriented, proactive, and committed to clear communication with both patients and payers. No prior experience required; training provided.

KEY RESPONSIBILITIES:

Insurance Verification & Eligibility

• Verify insurance coverage and patient eligibility for upcoming services through payer portals or direct calls.
• Confirm co-pays, deductibles, coinsurance, and out-of-pocket costs; document all benefit details clearly in EHR/PM systems.
• Assign accurate codes for covered benefits and track policy limitations as they relate to scheduled services.
• Record all payer communications, including representative names, reference numbers, and dates of contact.
• Utilize payer checklists and follow standard scripts to ensure consistency and completeness.

Prior Authorization Management

• Determine if prior authorization is possible and submit authorization requests accordingly.
• Follow up regularly with insurance companies to ensure timely approvals and respond to additional documentation requests.
• Maintain accurate records of authorization status, reference numbers, and documentation provided (including authorization letters, when applicable).
• Collaborate with clinical and billing teams to avoid delays in care or claim denials due to missing authorizations.

Data Management

• Maintain accurate and up-to-date patient insurance information in the EHR.
• Ensure all necessary documentation is obtained from multiple sources and recorded accurately.
• Generate reports on insurance verification, pre-determination, and pre-authorization activities.

Patient Communication

• Proactively contact patients to confirm insurance details and explain financial responsibilities before services are rendered.
• Answer questions regarding coverage, benefits, and prior authorizations in a clear and supportive manner.
• Assist in setting accurate expectations regarding insurance reimbursement and out-of-pocket costs.

Collaboration & Compliance

• Coordinate closely with scheduling, billing, and clinical teams to ensure seamless patient flow and front-end revenue cycle accuracy.
• Maintain knowledge of local coverage determinations (LCDs) and national coverage determinations (NCDs) as they apply to insurance approvals.
• Stay up to date on insurance guidelines, prior authorization protocols, and payer-specific requirements.
• Follow HIPAA and all privacy regulations when handling patient and insurance information.

QUALIFICATIONS:

· No prior experience required; ideal for detail-oriented candidates eager to learn and grow within revenue cycle management.

· Strong communication and interpersonal skills, with a patient-first mindset.

· Excellent attention to detail, organizational habits, and ability to follow checklist-driven workflows.

· Comfortable navigating payer websites, portals, and EHR/PM systems (training provided).

· Ability to research payer-specific rules and coverage policies quickly and accurately.

· Familiarity with medical terminology, insurance plans, and reimbursement concepts is a plus.

Job Type: Full-time

Pay: $ $22.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person