Insurance Verification Specialist

Insurance Verification Specialist – Quad City Gastroenterology

Quad City Gastroenterology has an immediate need for a full‑time Insurance Verification Specialist to work closely with the Revenue Cycle Manager and support both existing and new patients through the insurance verification and authorization process. The role requires excellent customer service and collaboration with staff to ensure smooth operations.

• Use the current system to verify insurance and validate authorizations for scheduled patients, ensuring eligibility and benefits are correct for claim submission.
• Utilize the SSI online eligibility verification system or contact payers directly via telephone or website.
• Request pre‑authorizations for scheduled procedures, urgent procedures, and imaging studies.
• Accurately document account actions related to pre‑certification.
• Coordinate Peer‑to‑Peer reviews with providers for denied requests.
• Follow up on pending authorization requests in a timely manner.
• Communicate with the Patient Financial Advocate regarding patients’ financial responsibility to support front‑office copay collection; answer non‑medical questions and provide routine instructions.
• Maintain working knowledge of various payer types (commercial, governmental, Medicare, Medicaid, HMOs, etc.) and adapt to differing requirements.
• Review confirmation reports to identify payer rejection issues and implement procedures to reduce future rejections.
• Act as the connection between internal and external customers to assist in billing resolution and to Escalate issues affecting claim submission and payment.
• Conduct independent research before seeking management assistance.
• Identify billing or payer edit opportunities.
• Follow department policies and procedures to meet payer and regulatory requirements, including record retention, privacy, and confidentiality.
• Meet or exceed daily production goals defined by the manager.
• Assist management by training, guiding, and supporting other team members in resolving account issues through billing, collection, and denial processing techniques.
• Provide timely feedback to the manager on any areas of concern impacting billing or collections.
• Exclude clinical tasks related to patient care, such as assessing medical conditions or providing medical advice.

• High school diploma or equivalent.
• At least 1 year of experience in healthcare customer service, insurance verification, or billing systems is preferred.
• Familiarity with Microsoft Word, Excel, and Outlook is required.
• Ability to learn new software and systems.
• Ability to read and evaluate healthcare receivables information.
• Effective and accurate communication with staff, management, and payers.

$20.00/hr (Wages are determined based on qualifications and experience).

• Medical, dental, vision, disability, and life insurance.
• Paid time off (vacation & sick leave) – starting PTO accrual is 15 days per year.
• 401(k) retirement plan.
• Paid holidays.
• Health savings accounts and other healthcare & dependent flexible spending accounts.
• Employee Assistance Program and employee discount program.
• Voluntary benefits: pet insurance, legal insurance, accident & critical illness insurance, long‑term care, elder & childcare, AD&DD, auto & home insurance.