Insurance Verification Specialist

Insurance Verification Specialist – Full Time (Day Shift)

Schedule:

Monday–Friday, 9:00 AM – 5:30 PM

The Insurance Verification Specialist is responsible for ensuring that all patient admissions have verified insurance coverage and, where required, completed pre-certification/authorization prior to admission. This role is essential in supporting smooth patient intake, reducing claim denials, and safeguarding the hospital’s revenue cycle. The specialist works closely with Admissions, Utilization Review, and Clinical teams to confirm benefits, secure authorizations, and document all interactions with payors in accordance with hospital policy.

• Accurately verify patient insurance eligibility, coverage, benefits, and policy limitations for all payors, including commercial, Medicare, Medicaid, and managed care.
• Identify plan requirements such as pre-authorization, pre-certification, or referral mandates.
• Obtain pre-certification/authorization for inpatient, detox, psychiatric, and residential services before admission when applicable.
• Initiate and develop client data in the Commonwealth of PA WITS system as required for applicable accounts.
• Record all verification details in the hospital’s EMR, Net Smart MyAvatar and other required systems in real time.
• Maintain accurate, detailed logs of insurance contacts, reference numbers, and call notes.
• Communicate insurance coverage status and financial responsibility to the Admissions team promptly to support patient scheduling.
• Notify leadership of any coverage issues, high-risk cases, or patients requiring alternative funding arrangements.
• Adhere to HIPAA and all confidentiality regulations regarding patient and financial information.
• Follow hospital SOPs for insurance verification, pre-certification, and admissions documentation.
• Collaborate with Utilization Review to ensure ongoing authorizations are secured as required.
• Stay updated on insurance policy changes, payor requirements, and state/federal regulations impacting coverage for behavioral health and substance use disorder treatment.
• Other duties as assigned.