Benefit Verification Specialist

Job Title: Benefit Verification Specialist 
Department: RCM 
Location: Carolina Oncology Specialists-TBD 
Reports To: Billing Manager 

Position Summary 

The Benefit Verification Specialist is responsible for verifying patient insurance eligibility, benefits, and coverage prior to services being rendered. This role ensures accurate and timely benefit information to support patient care, financial counseling, and billing processes. The Benefit Verification Specialist plays a critical role in reducing claim denials, improving reimbursement outcomes, and enhancing the patient financial experience. 

Key Responsibilities 

• Verify patient insurance eligibility and benefits for all scheduled services 

• Confirm coverage details including copays, deductibles, coinsurance, out-of-pocket maximums and network status 

• Communicate benefit and coverage details to financial counselors, billing teams, and clinical staff 

• Document all verification details accurately in the electronic health record (EHR) or practice management system 

• Review payer responses to ensure completeness and accuracy of information obtained 

• Work closely with scheduling, financial counseling, and prior authorization teams to ensure timely financial clearance 

• Identify discrepancies in insurance coverage and resolve issues prior to services 

• Notify patients or appropriate staff of coverage limitations, out of network status or potential financial responsibility 

• Maintain knowledge of payer policies including Medicare, Medicaid, and commercial insurance plans 

• Ensure compliance with HIPAA and organizational policies when handling patient information 

• Assist in identifying trends in coverage issues or verification delays and escalate to leadership 

Qualifications 

Required: 

• High school diploma or equivalent 

• Minimum of 2–3 years of experience in patient access, insurance verification, or revenue cycle operations 

• Knowledge of insurance plans including Medicare, Medicaid, and commercial payers 

• Experience with EHR and practice management systems 

• Strong attention to detail and organizational skills 

• Excellent communication and customer service skills 

Preferred: 

• Experience in oncology or specialty healthcare setting 

• Familiarity with prior authorization and financial counseling workflows 

• Knowledge of payer portals and eligibility verification tools 

Key Competencies 

• High attention to detail and accuracy 

• Strong analytical and problem-solving skills 

• Effective communication and collaboration 

• Time management and ability to meet deadlines 

• Ability to manage multiple priorities in a fast-paced environment 

• Patient-focused and service-oriented mindset 

• Accountability and reliability 

Working Conditions 

• Primarily office-based or patient access environment 

• Frequent interaction with staff, patients, and insurance payers 

• Regular use of computers, phones, and payer systems 

Physical Requirements 

• Ability to sit for extended periods 

• Ability to use standard office equipment, including computers and telephones