Job Title: Insurance Verification Lead 

Classification: 1099 

Work Structure: Fully Remote

Hours/Shift: Monday-Friday, Day Shift (EST), 40 hours/week

Team: Enrollment Operations

Reports to: Sr. Program Manager

Location: United States (EST or CST Preferred)

Compensation: $25 per hour

About Us

We are a mission-driven organization of clinicians, engineers, and professionals dedicated to transforming cardiovascular health. Our focus is on reducing the impact of heart disease through innovative solutions. Leveraging evidence-based research and telemedicine, we deliver specialized exercise and wellness programs tailored to older adults. Our goal is to enhance patients’ lives by promoting heart health and offering exceptional care that makes a lasting impact.

Job Summary

As an Insurance Verification Lead, you will lead a team responsible for verifying patient insurance benefits and ensuring the necessary authorizations for treatments are obtained. This role involves analyzing insurance coverage, communicating with insurance providers, and collaborating across departments to streamline billing and authorization processes. You will play a key role in patient coordination and contribute to the company’s mission of improving heart health outcomes.

Key Responsibilities

Insurance Verification and Authorization

• Review and validate patient insurance information, ensuring accuracy in billing and demographic details.
• Determine member benefit coverage for treatments and procedures.
• Obtain and confirm prior authorizations from insurance companies and document patient accounts accordingly.

Team Leadership and Development

• Lead a team of insurance verification specialists, providing coaching and performance feedback to ensure high standards of insurance verification quality and accuracy.
• Manage training for team roles, maintaining alignment with operational goals and KPIs.

Patient Coordination and Communication

• Communicate with patients regarding co-pays, coverage, benefits, and care authorizations.
• Support cross-functional collaboration by sharing insurance authorization and appeals processes with providers and assisting the scheduling team.

Continuous Improvement and Performance Analysis

• Analyze and optimize outreach methods to improve patient engagement, collaborating with Product & Engineering teams to refine technical workflows.
• Develop best practices and evaluate key performance indicators (KPIs) for the insurance verification process.

Documentation and Compliance

• Maintain accurate records in compliance with HIPAA and ensure patient data confidentiality.
• Produce clear documentation to align teams and communicate complex workflows effectively.

Qualifications

Experience:

• 3-5 years of experience in member acquisition/retention for Medicare Advantage and commercial plans.
• 3-5 years of experience in benefits verification operations, including 2+ years in team management.
• Experience screening, hiring, and managing teams of 10+, with a track record of meeting KPIs.

Knowledge and Skills:

• Strong knowledge of healthcare topics, including insurance products, ICD-10 billing, CPT codes, and EHR systems.
• Proficiency with CRM, ticketing queues, spreadsheets, and outreach tools.
• Excellent electronic communication skills, both verbal and written, with a demonstrated ability to handle time-sensitive situations. Experience with Slack is a plus. 

Personal Attributes:

• Proactive, results-driven, and adept at handling fast-paced, startup environments.
• Strong work ethic, sound judgment, and a commitment to continuous improvement.
• Analytical mindset and problem-solving skills with experience in developing data-driven solutions.

Additional Information

This role requires adherence to HIPAA and company confidentiality guidelines. All employees must pass a background check.

This description provides an overview of the Insurance Verification Manager’s responsibilities and qualifications. As the company grows, job requirements may evolve to meet changing needs.

*Note: This is a 1099 contractor position