Insurance Verification Coordinator

We are seeking a detail-oriented and experienced Insurance Verification Specialist to join our Pain Management practice. In this role, you will be responsible for verifying insurance benefits and coverage for patients prior to services, ensuring a smooth billing process and enhancing the patient experience. This is a critical position that supports both clinical and administrative teams in delivering high-quality, timely care.

• Verify insurance eligibility and benefits for all new and existing patients prior to scheduled appointments, procedures, and treatments
• Conduct thorough benefit investigations for commercial, government, workers’ compensation, and personal injury insurance plans
• Obtain and document detailed information regarding patient coverage, including deductibles, co-pays, co-insurance, out-of-pocket maximums, and coverage limitations specific to pain management services
• Identify whether services require prior authorization, pre-certification, or referrals and initiate requests accordingly
• Contact insurance carriers and/or utilize payer portals to confirm coverage for procedures such as spinal injections, nerve blocks, diagnostic imaging, durable medical equipment (DME), and other interventional treatments
• Accurately calculate and communicate expected patient financial responsibility to patients prior to services, including any up‑front payment requirements
• Collaborate with front office staff to ensure patients are informed of their benefits and financial obligations at the time of scheduling or check‑in
• Maintain up‑to‑date records in the EMR system, including benefit summaries, authorization statuses, and documentation of all communication with insurance companies
• Monitor authorization expirations and service limits to ensure continued coverage
• Assist with resolving discrepancies related to patient billing, denied claims, or incorrect benefit applications by providing supporting documentation or benefit verification records
• Maintain a strong working knowledge of evolving payer policies, medical necessity criteria, and coding updates relevant to pain management procedures
• Ensure all processes comply with HIPAA regulations and internal policies regarding patient privacy and data security
• Support billing and front office teams with insurance-related tasks and participate in cross‑training efforts as needed
• Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”.
• Other duties as assigned based on business operational needs.