Insurance Verification Specialist

Blue Water Thinking is seeking an experienced and dedicated Insurance Verification Specialist to join our team, supporting the Department of Veterans Affairs. The primary responsibility of this position is to perform insurance verification and related billing activities, including verifying patient insurance coverage, eligibility, benefits, policy information, and reimbursement requirements to support accurate and timely claims processing for the Veterans Health Administration (VHA).

Responsibilities:

• Performs verification of patient insurance coverage through automated databases, direct patient contacts, and communication with insurance companies.
• Verifies insurance benefits, policy numbers, pre-certification requirements, eligibility, and effective dates of coverage.
• Accepts and completes work provided through a standardized control system, such as batched work, caseload levels, or other defined workflows.
• Performs Medicare and commercial insurance reimbursable billing activities.
• Ensures that all billable cases are accurately identified and that bills are generated correctly and timely.
• Validates claims for billing purposes, ensuring patient eligibility and referring questionable or potentially inaccurate coding for appropriate review.
• Reviews insurance and billing information to identify discrepancies, missing information, or issues that may affect reimbursement.
• Follows established instructions regarding timeliness, objectives, priorities, and workload requirements.
• Exercises sound judgment to determine the appropriateness and accuracy of data and information provided on claims.
• Effectively communicates with internal staff and other stakeholders as necessary to resolve billing, insurance, eligibility, and claim discrepancies.
• Uses a wide range of office software applications and electronic systems to document, process, track, and manage insurance verification and billing activities.
• Maintains accurate and complete documentation in accordance with applicable VA, VHA, contractual, and organizational requirements.
• Protects sensitive patient and insurance information and follows applicable privacy, security, and information-handling requirements.

Minimum Qualifications:

• High School Diploma or equivalent.
• Two years of experience in insurance verification, medical billing, healthcare revenue cycle, patient financial services, claims processing, or a related healthcare administrative function.
• Demonstrated experience verifying insurance eligibility, benefits, coverage dates, policy information, and authorization or pre-certification requirements.
• Experience working with Medicare and/or commercial health insurance claims and reimbursement processes.
• Proficiency with Microsoft Office applications, electronic databases, and other office or healthcare information systems.
• Strong attention to detail with the ability to accurately review claims, insurance information, and billing documentation while meeting established deadlines.

Preferred Qualifications:

• Experience supporting the Department of Veterans Affairs, Veterans Health Administration, or other federal healthcare programs.
• Experience with VHA or VA healthcare administrative, billing, eligibility, or revenue cycle processes.
• Familiarity with Medicare, commercial insurance, third-party billing, and healthcare reimbursement requirements.
• Knowledge of medical terminology, insurance terminology, claims processing, and healthcare revenue cycle workflows.
• Experience working with electronic health records, patient management systems, insurance verification platforms, or medical billing applications.
• Familiarity with claim validation, coding review processes, eligibility verification, and identifying billable services.
• Strong written and verbal communication skills with the ability to collaborate effectively with clinical, administrative, billing, and insurance personnel.
• Ability to manage multiple priorities, meet production and quality requirements, and work effectively within standardized workflows.
• Experience handling sensitive patient information in accordance with applicable privacy and security requirements.

Eligibility:

• Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.
• Must be able to obtain and maintain the required federal public trust clearance for this role.