Insurance Verification & Authorization Specialist
Core
Verify insurance eligibility, coverage, and behavioral health benefits for new and existing patients, and obtain prior authorizations to ensure timely access to care.
Role type
Insurance Operations Specialist (IC)
Builds
Patient access to mental health services
Domain
Healthcare / Behavioral Health
Required skills
Insurance verification, Eligibility determination, Prior authorizations, Referrals management, Insurance terminology, High-volume workflow management
Preferred skills
Behavioral health insurance benefits, Specialty healthcare, EHR systems (Athenahealth), Insurance portals, HIPAA compliance
Technologies
Athenahealth, Insurance portals
Responsibilities
Verify insurance eligibility, coverage, and behavioral health benefits for new and existing patients; Review incoming patient inquiries to confirm age, location, insurance participation, and service eligibility; Identify complexities within insurance plans, including third-party behavioral health administrators and payer-specific coverage requirements; Obtain, submit, and track prior authorizations and referrals to ensure timely access to care; Communicate with insurance carriers to resolve coverage discrepancies and explain patient financial responsibilities; Manage high-volume requests through internal ticketing and EHR systems, maintaining accurate documentation and collaborating with internal teams to resolve barriers to care.