Medical Billing Specialist / Insurance Claims Verifier
The company is a growing therapy group providing speech therapy services to children and families. We collaborate closely with providers and caregivers to deliver coordinated care and maintain a supportive, patient-first experience.
In this role, the Medical Billing Specialist / Insurance Claims Verifier is responsible for ensuring accurate insurance verification, efficient claim submission, and timely billing resolution so families receive clarity in their care costs and providers can deliver care without disruption.
The ideal candidate is detail-oriented, reliable, comfortable communicating with payers and families, and experienced in end-to-end medical billing workflows.
Your accuracy and communication will directly support the clinic's mission of delivering uninterrupted, high-quality care. By maintaining smooth billing operations and resolving claims efficiently, you ensure that both families and providers experience a transparent and stress-free financial process.
Core Responsibilities:
Insurance Verification & Patient Cost Estimates 35%
- Verify insurance eligibility and benefits using Availity and payer portals.
- Contact insurance companies for coverage clarification and policy details.
- Generate accurate cost estimates for evaluations and ongoing care.
- Communicate estimates to families in a clear, supportive, and timely manner.
- Confirm in-network status and coordinate with credentialing as needed.
Authorizations & Referral Management 25%
- Submit prior authorization and referral requests for services requiring approval.
- Track authorization limits, expirations, and visit usage for ongoing treatment.
- Communicate authorization status updates with providers and administrative staff.
- Resubmit authorizations or follow up on pending determinations to prevent service disruption.
Billing & Claims Processing 30%
- Enter and reconcile patient charges across two EMR systems.
- Manage copays, co-insurance, and upfront evaluation payments.
- Resolve claim errors that prevent submission and address payer denials.
- Conduct denial research, correct claim issues, and resubmit as necessary.
- Coordinate with clearinghouse and coding as needed and complete write-offs per policy.
Documentation Validation & Patient Communications 10%
- Confirm provider notes are submitted on time and meet billing documentation standards.
- Serve as the primary contact for patient billing questions via email/tickets.
- Ensure responses are clear, empathetic, and consistent with billing policies.