The Back-End Insurance Verification Specialist is responsible for verifying insurance eligibility, benefits, and authorizations after services have been rendered. This role ensures accurate billing and claims processing by confirming insurance information, resolving discrepancies, and working closely with billing and clinical teams to support timely reimbursement.
Verify insurance coverage and benefits for services already provided to patients, ensuring correct claim submission.
Review and correct insurance-related errors or discrepancies in patient accounts.
Follow up with insurance carriers to confirm eligibility, policy status, and authorization requirements post-service.
Update and maintain accurate insurance information in the patient billing system or EMR.
Work closely with billing and collections teams to resolve denials and support appeals processes.
Communicate with patients as needed to obtain missing or updated insurance information.
Maintain knowledge of payer guidelines, benefits, and authorization requirements for a wide range of plans (PPO, HMO, Medicare, Medicaid, etc.).
Document all actions taken in the patient account for audit and compliance purposes.
Ensure compliance with HIPAA and other applicable regulations during all communications and data handling.
Meet productivity and accuracy benchmarks as set by department leadership.
High school diploma or equivalent required; some college or medical billing coursework preferred.
2+ years of experience in insurance verification, preferably in a back-end or post-service role.
Familiarity with EMR systems and insurance portals (e.g., Availity, payer websites).
Strong understanding of insurance plans, medical billing, CPT/ICD codes, and healthcare reimbursement practices.
Excellent attention to detail and problem-solving skills.
Ability to work independently and prioritize in a fast-paced environment.
Strong communication and organizational skills.