Insurance Verification Representative

Some roles may be based outside of our Colorado office (remote-only positions). Roles based outside of our primary office can sit in any of the following states: AZ, CO, CT, FL, GA, ID, IL, KS, MA, MD, MI, MN, NC, NJ, OH, OR, PA, SC, TN, TX, UT, VA, WA, and WI. Please only apply if you are able to live and work primarily in one of the states listed above. State locations and specifics are subject to change as our hiring requirements shift.

About the Opportunity:

This role is responsible for the accurate and timely verification of insurance and benefits information for patients at Vail Health. The position plays a key role in supporting the organization’s financial health by ensuring financial clearance prior to service and maintaining accurate patient demographic and insurance information for proper claims processing.

Schedule:
This position operates on a standard schedule of 8:00 AM – 4:30 PM MST and requires adherence to this time zone regardless of location.

What You Will Do:

• Utilize online systems, phone communication, and other resources to determine eligibility and benefits prior to scheduled appointments in accordance with Vail Health timelines
• Accurately identify and assign payer plan codes in the organization’s electronic health record system
• Verify medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards and communicate coverage and eligibility details to patients
• Communicate with patients, physicians, clinicians, front-end staff, and translators to gather any additional required information
• Identify and obtain missing patient demographic, insurance, or pre-authorization details
• Coordinate benefits by determining primary and secondary liability when applicable
• Obtain pre-certifications and pre-authorizations from third-party payers per payer requirements
• Escalate complex cases and notify patients or physician offices of any issues impacting verification or eligibility
• Communicate patient financial responsibility directly or partner with appropriate staff to review payment and financial assistance options
• Demonstrate and uphold the principles of a Just Culture
• Perform other duties as assigned; must remain HIPAA compliant

This description is not intended to be an exhaustive list of all responsibilities, skills, or working conditions, but rather an overview of the general scope of the role.

What You Will Need:

Experience:

• One year of customer service experience preferred
• Insurance verification or healthcare experience preferred
• At least one year of professional experience using Epic, specifically working with and verifying Physical Therapy and/or Occupational Therapy workflows, is strongly preferred.

License(s) & Certification(s):

• N/A

Education:

• Degree in healthcare administration or a related field preferred