Insurance Verification Specialist

Top Job

Located in Exton, PA

Salary: 18-22

Our client is an AI and automation company with deep engineering and data expertise, dedicated to serving the healthcare industry.
Insurance Verification Specialist
Monday - Friday 8am-5pm
6 Month Contract  - start ASAP
$18-$22/hour

 

Essential Functions:
-Receives, organizes, and reviews all incoming Medicare FFS prior authorization fax requests and all other documentation.
-Verifies Medicare Part A/B eligibility and confirms whether services fall under Medicare-required prior authorization categories (e.g., DME, repetitive services, applicable outpatient procedures).
-Validates patient demographics, Medicare beneficiary information, and associated coverage details.
-Reviews Medicare billing, coding, and coverage requirements, ensuring diagnosis and procedure codes support medical necessity based on CMS guidelines.
-Ensures all work complies with CMS regulations, Medicare FFS policies, and HIPAA.

Must Have:
-Strong understanding of Medicare Fee-For-Service coverage rules, prior authorization criteria, and CMS documentation requirements.
-Ability to interpret medical records, clinical documentation, NCD/LCD criteria, and Medicare coverage policies.
-High attention to detail, with the ability to identify missing or incomplete elements in prior authorization packets.
-Excellent written and verbal communication skills.
-Proficiency with EMR systems, authorization platforms, fax management systems, and Microsoft Office.
-Ability to work efficiently in a fast-paced, deadline-driven environment.
-Knowledge of HIPAA and federal compliance regulations.
-High school diploma or GED required.
-One (1) year of revenue cycle or medical administrative experience in a clinical, hospital, vendor, or ASC setting.
-One (1) year of experience with Medicare insurance verification or prior authorization preferred.

 

 

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