Insurance Verification Representative

Verifies patient insurance coverage and benefit information. Obtains authorizations from insurance carriers prior to providing care/treatment to patients. Documents referrals, communications, insurance details, and patient data in the electronic medical record (EMR). Gathers information, handles inquiries, and accurately enters codes for insurance billing purposes.

Essential Functions

Verify insurance companies and primary care physicians (PCP) online or over the phone to obtain benefit information

Complete billing tasks in a timely manner

Call primary care physicians to obtain referrals and/or authorizations when required

Inform patients regarding their insurance benefits, copays, deductibles, and self-pay balance due

Enter the authorization number in EMR with the correct CPT codes, NPI, Tax ID, PCP, and payer information

Follow up with the PCP or the insurance company for the authorization requested

Cancel and reschedule the patient's appointment when the authorization has not arrived prior to the DOS

Check if the patient's insurance information is correct and matches the insurance verification, and expire all inactive payers

Answer phones promptly and courteously; handle requests and inquiries, or route accordingly

Job Specifications

Typically has the following skills or abilities:

Customer Service experience

Ability to handle multiple tasks simultaneously in a fast-paced environment

Ability to handle and diffuse patient complaints and disagreements

Exceptional communication and interpersonal skills

Experience navigating Electronic Medical Records and Outlook preferred

Bilingual in English/Spanish

For roles that are remote (i.e., Work From Home (WFM)) or hybrid (i.e., partial onsite at a VSP location and WFM), must demonstrate a high level of engagement in virtual environments, including maintaining camera presence during meetings to support effective communication and team alignment