Insurance Verification Specialist

Role Overview

• Run partial insurance verification immediately upon referral intake
• Confirm in-network status and identify credentialed providers by department
• Flag inactive, incorrect, or out-of-network insurance before patient contact
• Complete full benefits verification once service type is confirmed
• Obtain co-pay and deductible information by service type
• Rework incorrect or missing insurance information — approx. 10–20% of referrals
• Maintain and update provider credentialing database by insurance
• Update patient records with all verified benefits information

Requirements

• 1+ year experience in medical insurance verification or revenue cycle management
• Knowledge of behavioral health benefits — mental health billing differs from medical
• Familiarity with EOBs, co-pays, deductibles, and in/out-of-network rules
• Detail-oriented with strong data entry accuracy
• HIPAA knowledge and compliance awareness
• Experience specifically in behavioral health or psychiatric practice billing
• Certified Medical Reimbursement Specialist (CMRS) or similar credential
• Familiarity with South Carolina Medicaid and major commercial plans
• Experience with multi-provider credentialing databases