Valora Medical Group
Insurance Verification Specialist
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Valora Medical Group
The Insurance Verification Specialist is responsible for verifying patient insurance coverage, benefits, and eligibility to ensure accurate billing and minimize claim denials in a primary care setting. This role plays a critical part in the revenue cycle process by confirming coverage prior to appointments, obtaining prior authorizations when necessary, and communicating with patients and staff regarding insurance requirements. The Insurance Verification Specialist works closely with the front desk, billing team, and clinical staff to support a smooth patient experience and efficient claims processing.
Essential Duties and Responsibilities
Work outstanding claims, denials, appeals, and aging reports to determine the appropriate follow-up action.
Verify patient insurance eligibility, coverage, and benefits prior to scheduled appointments and procedures.
Answer calls with billing or insurance questions.
Obtain prior authorizations and referrals from insurance companies when required.
Accurately document verification details and authorization numbers in the EMR system.
Collect all information necessary to prepare claims accurately before patients are billed.
Ensure the correct ICD‑10 and CPT codes on claims are accurate for billing purposes.
Ensure all scheduled follow‑ups with patients and insurance carriers are completed in a timely manner.
Review and interpret EOB denial and remark codes.
Meet individual and department goals set forth by management.
Notate all calls, resubmissions, adjustments, and collections in accordance with departmental policies and procedures.
Communicate with patients regarding delinquent accounts.
Ensure all necessary documentation and information is correct according to departmental policies and procedures.
Post payments, including both patient and insurance payments.
Perform additional duties as assigned by management.
Qualifications
High School Diploma or equivalent required.
Bilingual in English and Spanish is highly preferred.
Primary Care billing experience preferred.
Minimum of 1 year experience with EMR System E‑Clinical Works (eCW) required.
Knowledge of medical and billing terminology, including ICD‑10 and CPT coding preferred.
Intermediate experience with Microsoft Office, specifically Excel.
Effective written, verbal communication, and interpersonal skills.
Professionalism at all times.
Ability to explain complex information to others.
Ability to establish working relationships, resolve interpersonal conflicts, and apply basic staff etiquette.
Ability to handle confidential information with discretion.
Strong analytical skills with attention to detail.
Quick learner, adaptable, and eager to adopt new procedures.
Multitasking and priority management.
Innovative, motivated, organized, and a team player.
Proactive and self‑starter.
Commitment to follow through on responsibilities.
Seniority Level Entry Level
Employment Type Full‑time
Job Function Other
Industries Hospitals and Health Care
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at
Valora Medical Group
The Insurance Verification Specialist is responsible for verifying patient insurance coverage, benefits, and eligibility to ensure accurate billing and minimize claim denials in a primary care setting. This role plays a critical part in the revenue cycle process by confirming coverage prior to appointments, obtaining prior authorizations when necessary, and communicating with patients and staff regarding insurance requirements. The Insurance Verification Specialist works closely with the front desk, billing team, and clinical staff to support a smooth patient experience and efficient claims processing.
Essential Duties and Responsibilities
Work outstanding claims, denials, appeals, and aging reports to determine the appropriate follow-up action.
Verify patient insurance eligibility, coverage, and benefits prior to scheduled appointments and procedures.
Answer calls with billing or insurance questions.
Obtain prior authorizations and referrals from insurance companies when required.
Accurately document verification details and authorization numbers in the EMR system.
Collect all information necessary to prepare claims accurately before patients are billed.
Ensure the correct ICD‑10 and CPT codes on claims are accurate for billing purposes.
Ensure all scheduled follow‑ups with patients and insurance carriers are completed in a timely manner.
Review and interpret EOB denial and remark codes.
Meet individual and department goals set forth by management.
Notate all calls, resubmissions, adjustments, and collections in accordance with departmental policies and procedures.
Communicate with patients regarding delinquent accounts.
Ensure all necessary documentation and information is correct according to departmental policies and procedures.
Post payments, including both patient and insurance payments.
Perform additional duties as assigned by management.
Qualifications
High School Diploma or equivalent required.
Bilingual in English and Spanish is highly preferred.
Primary Care billing experience preferred.
Minimum of 1 year experience with EMR System E‑Clinical Works (eCW) required.
Knowledge of medical and billing terminology, including ICD‑10 and CPT coding preferred.
Intermediate experience with Microsoft Office, specifically Excel.
Effective written, verbal communication, and interpersonal skills.
Professionalism at all times.
Ability to explain complex information to others.
Ability to establish working relationships, resolve interpersonal conflicts, and apply basic staff etiquette.
Ability to handle confidential information with discretion.
Strong analytical skills with attention to detail.
Quick learner, adaptable, and eager to adopt new procedures.
Multitasking and priority management.
Innovative, motivated, organized, and a team player.
Proactive and self‑starter.
Commitment to follow through on responsibilities.
Seniority Level Entry Level
Employment Type Full‑time
Job Function Other
Industries Hospitals and Health Care
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