Verification Specialist

Location:

Oncology Consultants - Business Office

Pay Range:

$17.93 - $29.89

Position Summary

Responsible for the overall verification of patients’ health coverage with patients’ insurance company to ensure necessary procedures are covered by the provider prior to patient appointments.Responsible for entering primary and secondary insurance data in an accurate manner, verify that existing information is accurate, and to update patient benefit information in the system. Responds to all internal and external phone inquiries regarding patient benefits and financial obligations. Interaction with front office staff and insurance companies on a daily basis is necessary in order to coordinate patients’ insurance information and compete the verification process.

Key Performance Areas

KPA 1 — Insurance Eligibility & Benefits Verification

• Verify insurance eligibility and benefits specific to radiation treatment services.

• Verify eligibility and benefits and load insurance information for patients with new or changed insurance coverage.

• Re-verify eligibility and benefits for existing patients prior to the first visit of each new calendar year.

• Review daily schedules and add-on appointments to identify patients requiring re-verification.

• Research and resolve eligibility response errors and discrepancies.

• Validate Medicare coverage and confirm whether patients are enrolled in Medicare replacement plans.

• Confirm that insurance plans and network participation have not changed prior to service delivery.

KPA 2 — Insurance Updates & Referral Coordination

• Notify appropriate internal departments and stakeholders of all insurance changes.

• Coordinate with Authorization staff to obtain required referrals and supporting documentation.

• Ensure insurance records are accurate and updated within applicable systems.

• Escalate complex coverage or eligibility issues to appropriate leadership or support teams.

KPA 3 — Communication & Service Excellence

• Communicate clearly and timely with patients and staff via company email and approved communication tools.

• Interact professionally with patients, clients, physicians, and fellow employees.

• Provide responsive, accurate, and timely service to both internal and external customers.

• Support a positive patient and team experience through courteous and solution-oriented communication.

KPA 4 — Team Collaboration & Operational Support

• Cooperate with team members to accomplish departmental and organizational goals.

• Work collaboratively across departments to resolve eligibility and coverage issues.

• Support workflow changes and operational improvements.

• Assist with additional operational or administrative tasks as assigned by management.

KPA 5 — Compliance, Reliability & Continuous Improvement

• Understand and adhere to organizational policies, procedures, and compliance standards.

• Maintain confidentiality and accuracy in handling patient and insurance information.

• Arrive at work as scheduled and notify supervisors timely of absences or schedule changes.

• Recognize priorities and manage time productively.

• Take initiative to resolve problems and conflicts when possible.

• Contribute ideas for improved processes and workflow efficiencies.

• Perform other duties as directed by physician, supervisor, or administrator.

Position Qualifications

Education

• High school diploma or equivalent required.

Minimum Relevant Experience

• 2 or more years of experience in healthcare verification/authorization insurance

• Medical and Oncology experience preferred.

Skills

• Spanish bi-lingual preferred.

Travel:  0-25%