Insurance Eligibility and Benefits Specialist

Job Description

Job Description

Job Summary: The Insurance Eligibility and Benefits Specialist maintains a vital role in ensuring timely and accurate verification of insurance coverage for mental health services before services are rendered. This position is responsible for confirming patient eligibility, obtaining benefit information, and assisting patients and clinical staff in understanding insurance requirements and financial responsibilities.

QUALIFICATIONS:

1. High school diploma or GED required, associate degree in healthcare administration or related field preferred.
2. Minimum of 2 years of experience in medical or mental health insurance verification, billing, or patient access required.
3. Experience working with mental health payers (e.g., Commercial, Medicaid, Medicare, Medicare Advantage) strongly preferred.
4. Experience with MS Office products and other spreadsheet applications.
5. Ability to coordinate workflow and train other employees.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Core Competencies

Verifies insurance eligibility and benefits for all new and returning mental health patients prior to appointments, including outpatient therapy, psychiatry, and intensive programs.

Obtains detailed benefit information such as copays, coinsurance, deductibles, visit limits, and authorization requirements.

Accurately documents verification results in the electronic health record (EHR).

Communicates insurance coverage details and estimated out-of-pocket costs to patients and/or Practice Management in a clear and confidential manner.

Obtains prior authorization, pre-certification, and referral requirements from payers.

Collaborates with the clinical, scheduling, and billing teams to ensure insurance information is accurate and up to date before services are rendered.

Monitors and follows up on changes in insurance status, denials related to eligibility, and authorization expirations.

Maintains current knowledge of payer requirements specific to mental health coverage, including telehealth policies and visit limitations.

Assists patients in understanding insurance terminology and benefits related to mental health services.

Supports the billing team with insurance-related claim resolution when eligibility or benefit issues arise.

Handles sensitive patient information in accordance with HIPAA and organizational confidentiality standards.

Communicates in a professional manner with all levels of staff, insurance companies, patients, families, and vendors with courtesy and respect.

Departmental Competencies

Understands and uses AVATAR and Meditech to efficiently perform job.

Strong understanding of mental health insurance benefits, including therapy and psychiatry coverage, telehealth, and utilization review processes.

Proficient in interpreting Explanation of Benefits (EOBs), verification reports, and payer correspondence.

Excellent communication and interpersonal skills, with the ability to interact compassionately with patients seeking mental health services.

Strong organizational skills, attention to detail, and accuracy in data entry.

Ability to manage multiple verifications in a fast-paced environment while maintaining accuracy and professionalism.

Understands and uses clearinghouse software and provider websites to perform accurate and timely insurance eligibility & verification inquiries

Performs additional department tasks, as assigned by Supervisor/Manager timely and accurately.

Days
40 Hours per week