Insurance Verification Specialist

 Billing Specialist Job Description 

About Bluebird Kids Health

Bluebird Kids Health is a dynamic organization that provides underserved communities with new access to value-based pediatric primary care. We are on a mission to provide exceptional care, so every child can thrive. We offer comprehensive, evidence-based primary and urgent care services to children and their families, with support around-the-clock. Our care model includes robust care coordination, chronic disease management, and other population health supports. Our success is measured by exceptional health outcomes, lower medical costs, an outstanding child and family experience, and a rewarding environment for our clinicians and teams.

Immediate Supervisor: Billing Manager

General Job Summary: Primary responsibilities include reviewing patient insurance eligibility issues in advance of scheduled visits across all practice sites; identifying and resolving insurance issues before they can disrupt a visit or delay claims submission; and serving as the connective link between our central patient scheduling teams, our practice-based teams, and the billing team on all insurance- and eligibility-related questions.

The individual will act as the primary escalation contact for our central scheduling teams on pre-visit insurance issues, serve as the main point of contact for practice teams (e.g., our reception teams) on day-of-visit eligibility questions, and follow up post-visit to resolve any lingering Primary Care Provider (PCP) assignment or Coordination of Benefits (COB) issues. The individual will also respond to patient and payer inquiries in a timely manner and perform special projects as directed.

Essential Job Responsibility: 

• Reviews insurance eligibility and coverage issues across practice sites for new and existing patient appointments three (3) days out (leveraging automated eligibility checks from our Electronic Health Record (EHR) system).
• Reaches out to payers (e.g., via phone or payer portal) and communicates proactively with families to resolve insurance issues prior to a visit. Flag open issues for practice teams for follow-up on day of visit.
• Serves as the primary escalation contact for the central operations scheduling team on pre-visit insurance and eligibility issues.
• Serves as the main point of contact for practice-based teams (e.g., reception) on day-of-visit insurance eligibility questions.
• Follows up post-visit on lingering primary care provider (PCP) assignment issues and Coordination of Benefits (COB) discrepancies with payers and patients/families.
• Ensures pertinent information relating to patient insurance and eligibility is documented accurately in the EHR.
• Works with front desk/reception staff to ensure appropriate collection of co-pay and self-pay fees based on verified benefits.
• Uses customer service principles and techniques to deal with patients calmly and pleasantly and assist with insurance-related questions or issues.
• Identifies trends in recurring eligibility, PCP assignment, or COB issues across sites and communicates them to leadership.
• Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations.
• Performs other duties as assigned

Education:High school diploma or equivalent with excellent computer skills  

Experience: Insurance verification, medical billing, or other relevant healthcare practice experience required (preference for primary care)

Location: Hybrid (Palm Beach County) or Remote (Florida only)

Knowledge: 

• Knowledge of basic health insurance terminology.
• Knowledge of basic differences across payer types (e.g., Commercial insurance vs. Medicaid) and plan types (e.g., HMO vs. PPO products).
• Knowledge of customer service principles and techniques.

Skills: 

• Experience with Athena EHR System preferred
• Excellent interpersonal skills, including friendliness, empathy, patience, kindness, politeness and helpfulness.
• Strong attention to detail.

Abilities: 

• Ability to work independently and as part of a team with a strong sense of focus.
• Ability to communicate calmly and clearly with patients and payer representatives. 
• Ability to analyze situations and respond appropriately.