Reimbursement Specialist – Insurance Verification
NAVERIS
full-time
Posted on:
Location Type: Remote
Location: Remote • Massachusetts, North Carolina • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Verify patient insurance coverage, eligibility, and benefits by contacting payers and using electronic verification tools
- Accurately enter and maintain patient demographic and insurance information in billing systems and payer portals
- Obtain medical records or supporting documentation for priority payers when not received with the order
- Collaborate with internal teams, healthcare providers, insurance companies, and patients to gather information needed for accurate billing
- Identify front-end delays or issues impacting reimbursement and recommend solutions
- Maintain detailed and accurate documentation of eligibility verification and payer communications
- Communicate with patients to explain insurance-related processes, benefit coverage, EOBs, and financial responsibility for non-clinical inquiries
- Maximize utilization of systems, tools, and resources to support front-end reimbursement activities
- Review payer correspondence and EOBs to validate coverage determinations and identify discrepancies related to eligibility or benefits
- Ensure compliance with all Federal and State billing regulations and company policies, including HIPAA
Requirements
- 4+ years of experience in reimbursement, insurance verification, or revenue cycle management within a diagnostics company, laboratory, or commercial payer environment
- Bachelor’s degree or equivalent experience
- Experience with Xifin, Quadax, or Telcor preferred
- Strong understanding of medical benefit structures, including Federal, State, PPO, HMO, and indemnity plans
- Working knowledge of CPT, ICD-10, and HCPCS coding, as well as LCD/NCD coverage guidelines
- Strong problem-solving skills with attention to detail, judgment, and follow-through
- Excellent verbal and written communication skills with a strong customer service orientation
- Strong troubleshooting, organizational, and time-management skills
- Ability to adapt to changing business needs
- Self-starter who can work independently
Benefits
- Competitive compensation
- Work/life balance
- Remote work opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
insurance verificationrevenue cycle managementmedical benefit structuresCPT codingICD-10 codingHCPCS codingLCD coverage guidelinesNCD coverage guidelinesbilling systemspayer portals
Soft skills
problem-solvingattention to detailjudgmentfollow-throughverbal communicationwritten communicationcustomer service orientationtroubleshootingorganizational skillstime-management