Verification of Benefits & Authorization Specialist

We are a growing Sleep Medicine practice seeking a detail-oriented Verification of Benefits & Authorization Specialist to join our team remotely. In this role, you'll serve as a critical link between our patients, providers, and insurance payers — verifying coverage, securing prior authorizations, and ensuring patients receive timely care without avoidable billing surprises or claim denials.

The ideal candidate thrives on accuracy, knows their way around payer portals, and can juggle multiple authorization requests while keeping providers and patients informed every step of the way.

Key Responsibilities:

• Verify patient insurance eligibility and benefits (in-network and out-of-network) prior to scheduled appointments, procedures, and services via payer portals, clearinghouses, and phone
• Obtain, track, and follow up on prior authorizations and retrospective authorizations for office visits, diagnostic testing, and procedures
• Accurately document benefit details, authorization numbers, effective dates, and payer requirements in the practice management system / EHR
• Calculate patient financial responsibility (copays, coinsurance, deductibles) to front-office staff and patients
• Identify authorization requirements by payer and CPT code, and flag services at risk of denial before they are rendered
• Monitor pending authorizations and proactively escalate delays that could impact patient care or scheduling
• Collaborate with providers, clinical staff, schedulers, and billing to resolve coverage issues and reduce claim denials
• Respond to authorization-related denials by gathering documentation and initiating appeals or retro-authorizations when appropriate
• Stay current on payer policy changes, medical necessity criteria, and authorization workflows
• Maintain compliance with HIPAA and all applicable privacy and security standards

• High school diploma or equivalent
• Minimum of four (4) years of experience in insurance verification, prior authorization, retrospective authorizations or medical billing in a physician practice or outpatient setting
• Working knowledge of commercial insurance, Medicare, and Medicaid plans, including HMO/PPO structures and authorization processes
• Familiarity with CPT, ICD-10, and HCPCS coding as it relates to eligibility and authorization
• Experience using payer portals (e.g., Availity) and practice management / EHR systems
• Strong attention to detail, organization, and follow-through
• Excellent written and verbal communication skills
• Ability to work independently in a remote environment with reliable high-speed internet and a private, HIPAA-compliant workspace

Happy Health is an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.