Insurance Verification Executive

Insurance Eligibility Verification

• Verify patient insurance eligibility using insurance payer websites, clearinghouses,

and outbound calls.

• Confirm active insurance coverage before scheduled appointments or medical

procedures.

• Validate patient demographic information and insurance details.

• Ensure all insurance information is accurate and up to date in the practice

management system.

Benefits Verification

• Verify and document:

o Co-payment

o Deductible

o Co-insurance

o Out-of-pocket expenses

o Coverage limitations

o Lifetime benefits

o Network participation

• Determine covered and non-covered medical services.

Prior Authorization & Referral Verification

• Verify whether prior authorization is required for scheduled procedures or

treatments.

• Identify referral requirements based on insurance plans.

• Coordinate with insurance providers and physician offices to obtain necessary

authorizations.

• Track authorization status and maintain proper documentation.

Insurance Communication

• Contact insurance companies to verify policy details and benefit information.

• Resolve discrepancies related to insurance eligibility or coverage.

• Escalate complex verification issues to the appropriate internal teams when

necessary.

Documentation & Data Management

• Record accurate verification details in the Practice Management (PM) or Electronic

Medical Record (EMR) system.

• Maintain complete documentation of insurance conversations and verification

outcomes.

• Update patient accounts with verified insurance information.

Coordination with Internal Teams

• Work closely with:

o Scheduling Team

o Front Office

o Medical Billing Team

o Payment Posting Team

o Accounts Receivable (AR) Team

• Communicate verification findings promptly to avoid billing delays.

Compliance

• Ensure compliance with HIPAA regulations and patient confidentiality policies.

• Follow company Standard Operating Procedures (SOPs) and payer-specific

guidelines.

• Maintain data accuracy while handling sensitive patient information.

Quality & Productivity

• Meet daily productivity targets and quality benchmarks.

• Ensure minimal insurance-related claim denials due to verification errors.

• Participate in process improvement initiatives and training programs.