Insurance Verification Specialist

Description

Who We Are

At AVP•SEES Group, exceptional patient care starts with exceptional people. As one of the largest eye care networks in the Southeast and Mid-Atlantic, we provide our teams with the training, technology, and support they need to thrive while making a difference in patients' lives. Together, we're building the future of eye care.

Our Mission

To deliver the best possible outcomes for our patients, serve and educate our provider network, and fulfill our commitment to our stakeholders.

Why Join Us?

· Paid Training & Career Development

· Growth & Advancement Opportunities

· Supportive Team Environment

· Competitive Benefits Package

· Tuition Reimbursement Opportunities

· Employee Eyewear Discounts

· Referral Bonus Program

· Make a Meaningful Difference Every Day

About the Role

As an Insurance Verification Specialist, you are responsible for filing insurance claims, managing patient accounts, and answering inquiries on account status and charges from ophthalmology surgery patients. Insurance verification specialists are responsible for collecting surgery patient’s insurance information, communicating directly with patients to quote their day of surgery costs, and posting surgery charges and payments as needed. This position is also responsible for ensuring all surgery patients have prior authorization as needed for their procedures. Responsible for documenting all customer interactions in the appropriate computer system.

What You’ll Do

• Accurately enter and submit professional and facility insurance claims, including diagnosis, procedure, modifier, provider, and patient insurance information.
• Process claims through the practice management and EHR systems and maintains knowledge of UB-04 billing requirements.
• Verify insurance eligibility, benefits, authorizations, coverage limits, and patient financial responsibility prior to services and surgeries.
• Communicate with patients regarding copays, deductibles, coinsurance, out-of-pocket expenses, and coverage determinations.
• Follow up on denied, rejected, unpaid, or underpaid claims and take appropriate action to resolve and resubmit as needed.
• Post charges, insurance payments, patient payments, adjustments, and refunds accurately and timely.
• Submit secondary claims and manage coordination of benefits.
• Monitor and collect outstanding patient balances, including performing soft collection activities and coordinating accounts sent to collections.
• Perform daily balancing procedures and maintain accurate financial records.
• Ensure compliance with HIPAA regulations and payer guidelines.
• Meet departmental productivity, quality, and service standards while supporting organizational and process improvement initiatives.
• Collaborate effectively with providers, patients, insurance carriers, and team members to deliver exceptional customer service.
• Demonstrate professionalism, accountability, attendance reliability, adaptability, and strong problem-solving skills.
• Promote a positive, patient-centered, team-oriented work environment.
• Perform other duties and special projects as assigned.

Core Competencies

• Medical billing and insurance claims processing
• Benefits verification and prior authorizations
• Revenue cycle and accounts receivable management
• Customer service and patient communication
• Attention to detail and accuracy
• Problem-solving and critical thinking
• Teamwork and collaboration
• HIPAA compliance and confidentiality
• Time management and multitasking in a fast-paced environment

Requirements

What You Bring

• High School Diploma
• Computer skills that include a combination of experience in a Windows Operating System, e-mail, and data entry experience.
• Ability to look up ICD-10 diagnosis and CPT treatment codes from online service or traditional coding references.
• Prior experience with medical billing software
• At least one year of insurance billing experience in a previous job. (Call Center, Scheduling Department, Medical/Dental Front Office)
• 2 years of experience in a medical office setting.
• Prior experience in an Optometry/Ophthalmology practice
• Prior experience with Compulink software.
• Willingness to submit to a background check

Compensation

Actual compensation is determined based on qualifications, experience, certifications, internal equity, and business needs.

Benefits May Include:

• Medical, Dental & Vision Insurance
• 401(k)
• Paid Time Off & Holidays
• Life & Disability Insurance
• Tuition Reimbursement
• Continuing Education Support
• Certification Sponsorship
• Employee Eyewear Discounts
• Referral Bonus Opportunities

Ready to Join Our Team?

If you're passionate about patient care, professional growth, and making a lasting impact, we'd love to hear from you. Apply today and help us build the future of eye care.

Additional Information:

Physical Requirements

The physical demands described here are representative of those that must be met to successfully perform the essential functions of this position, with or without reasonable accommodation.

• Ability to remain stationary for extended periods
• Frequent use of hands, fingers, and computer equipment
• Ability to communicate effectively with patients and team members
• Ability to occasionally lift, carry, push, or pull up to 25 pounds

Compliance Requirements

• Annual compliance training is required.
• Compliance with HIPAA, OSHA, and company policies is required.
• Background screening may be required based on position.
• Drug screening may be required based on position and location.

Equal Employment Opportunity

AVP•SEES Group is an Equal Opportunity Employer committed to fostering an inclusive workplace. We provide equal employment opportunities to all applicants and employees without regard to any protected characteristic under federal, state, or local law.

Disclaimer

This job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all responsibilities, duties, and qualifications required for the position.