Insurance Verification & Authorization Specialist

As an Insurance Verification & Authorization Specialist, you'll help children and families access care by verifying insurance benefits, coordinating prior authorizations and referrals, and identifying potential coverage barriers. You'll review incoming patient requests, navigate complex behavioral health insurance requirements, and collaborate with internal teams and insurance carriers to ensure a smooth patient experience. Success in this role requires exceptional attention to detail, strong problem-solving skills, and the ability to manage a high-volume workflow. Internally, this position is referred to as an Insurance Operations Specialist. Employment Type: Full-Time, Hourly (Non-Exempt), Benefits Eligible. Location: Fully Remote, Eastern Time Zone preferred. Schedule: Monday-Friday, Eastern Time business hours.

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, including copays, coinsurance, and deductibles; Manage high-volume requests through internal ticketing and EHR systems, maintaining accurate documentation and collaborating with internal teams to resolve barriers to care

Requirements

Experience in healthcare insurance verification, eligibility, benefits determination, prior authorizations, or referrals; Strong understanding of insurance terminology, including copays, coinsurance, deductibles, and out-of-pocket costs; Exceptional attention to detail with the ability to manage high-volume workflows, investigate coverage discrepancies, and maintain accuracy; Strong communication, organizational, and problem-solving skills when working with patients, insurance carriers, and internal teams

Nice to have

Experience with behavioral health insurance benefits, prior authorizations, or specialty healthcare; Familiarity with EHR systems such as Athenahealth and insurance portals; Ability to maintain patient confidentiality and comply with HIPAA requirements

Benefits

Benefits eligible