Insurance Verification Representative

Locations

3510 Biscayne Blvd, Miami, FL 33137, USA

• Hybrid
• Travel Required:
  
  No
• Social Services
• Full-Time
• Requisition #: INSUR
  002279

The Insurance Verification Representative (IVR) assists Client Service Specialists in processing insurance eligibility for all Care Resource patients, including Medical, Behavioral Health, and Dental prior to scheduling appointments. The IVR conducts thorough verification of appointments on the providers’ schedule two days prior to the Date of Service (DOS), informing patients of financial obligations, prior authorization, and required referrals.

• Verify all commercial, Medicare, Medicaid, and Ryan White insurance eligibility and benefits for scheduled appointments, same-day and walk-ins.
• Create and maintain an account on all insurance portals to retrieve updated patient information.
• Ensure patient is seeing the provider assigned by their insurance and document alerts on Next Gen.
• Update the patient insurance tab, ensuring payer names, member IDs, effective dates, and PCP information are accurate.
• Clean the payer list, activating only active insurances.
• Document all recommendations and actions in patient chart notes for continuity of care.
• Resolve routine questions and issues presented by patients and customers regarding insurance eligibility and referrals.
• Work closely with client contact services departments and internal/external teams to identify patient financial responsibility.
• Provide accurate financial information to front desk support staff to facilitate collection at check‑in.
• Answer telephone calls promptly and professionally, addressing patient/client concerns.
• Model company culture of service standards, delivering gracious and efficient service with compassion and competency.
• Maintain knowledge of all services offered and resources available at the health center.
• Retrieve and respond to voice messages within 24 hours and access the patient portal to email queries and solutions.
• Log and track inquiries using computer systems, monitoring pending items for follow‑up.
• Document all customer/payer interactions in detail, including complaints and actions taken.
• Assist with special projects as needed.
• Comply with HIPAA rules and regulations when communicating with patients and stakeholders.

Ensure proper hand washing per CDC guidelines, understand and act upon the Emergency Code and Continuity of Operations Plan.

Greet internal or external customers courteously, use eye contact, proper tone, and nonverbal communication; listen attentively and provide appropriate resolutions.

Provide services following established protocols and procure additional help when necessary to deliver appropriate services.

Take initiative and anticipate customer needs, engaging them in the process and following up as needed, prioritizing requests for prompt response.

Participate in training sessions, meetings, and health center developmental activities as required.

High School diploma or GED required; college education in a related field preferred.

Two years of experience processing insurance verification for Medicare, Medicaid, and commercial payers required. Medical Billing/Coding Certification and knowledge of CPT and ICD‑10 are a plus.

Bilingual (English/Spanish or English‑Creole) required. Proficiency in Microsoft Word, Excel, Outlook, Electronic Health Records (Next Gen), and Availity highly recommended. Excellent customer service skills, phone etiquette, communication, organization, teamwork, and ability to work with diverse populations required.

Own transportation required.

Frequent sitting, bending, standing, walking, talking in person and on the phone. Occasional driving, stretching/reaching, and lifting to 50 lbs. Work performed in an office setting.

No. Own transportation required.

• Microsoft Office Advanced
• Team Player Advanced
• Phone Systems Intermediate
• Windows Advanced
• Verbal Communication Advanced
• Multitasking Advanced
• Interpersonal Skills Advanced
• HIPAA Advanced
• Excel Intermediate
• Email Advanced
• Customer Support Advanced
• Customer Focus Advanced
• Customer Service Advanced
• Computer Intermediate
• Communication Advanced
• Compassion Advanced
• Commitment Advanced
• Client Support Advanced

• Team Player – works well as a member of a group
• Enthusiastic – shows intense and eager enjoyment and interest
• Detail Oriented – capable of carrying out a given task with all necessary details

• Flexibility – inspired to perform well when granted the ability to set your own schedule and goals

Equal Opportunity Employer

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