Verification Specialist

SUMMARY: This position is responsible for the daily processing of patient and payer eligibility verification for ground ambulance transports, including Medicare, Medicaid, managed care, and third-party commercial insurance. The role verifies coverage for both emergency and non-emergency ambulance transports, confirms medical necessity documentation requirements, and identifies payer-specific prior authorization needs for scheduled/non-emergency transports (e.g., dialysis, discharge, and facility-to-facility runs). The daily productivity and quality standard is a minimum of 85 verifications per day utilizing web-based payer portals, clearinghouse tools (e.g., Waystar), and direct payer contact, while maintaining accuracy and completeness of eligibility data within the billing system (LOGIS).

ESSENTIAL DUTIES AND RESPONSIBILITIES:

(Responsibilities include, but are not limited to)

• Meets and/or exceeds the daily quota of Medicare, Medicaid, and commercial insurance verifications for ground ambulance transports.
• Verifies patient eligibility and benefits for both emergency (911) and non-emergency (scheduled) ambulance transports prior to or immediately following dispatch.
• Gathers all pertinent demographic, insurance, and guarantor information from the verification source at the initial encounter or dispatch record.
• Accurately documents verification results, authorization numbers, and payer notes in LOGIS to support clean claim submission.
• Takes necessary steps to obtain missing demographic or insurance information, including faxing facilities, contacting dispatch, and telephone communication with patients or family members when necessary.
• Follows HIPAA guidelines regarding the handling and dissemination of patient information throughout the verification process.
• Coordinates with billing, collections, and dispatch staff to resolve eligibility discrepancies and reduce downstream denials.
• Adheres to company policies and procedures.
• Regular attendance is an essential function of the position.
• Other duties as assigned.

KNOWLEDGE AND SKILLS:

• Ability to read, analyze, and interpret insurance plans and ambulance-specific coverage policies.
• Working knowledge of Medicare, Medicaid, and commercial insurance benefits as they apply to ground ambulance transport.
• Familiarity with ambulance billing terminology, including HCPCS transport codes, loaded mileage, and origin/destination modifiers, is preferred.
• Proficient in online/web-based payer portal verification as well as verbal (phone-based) verification.
• Must have accurate, high-level data entry skills with a continuous quality focus.
• Must have excellent phone and customer service skills.
• Must be detail oriented with excellent organizational and problem-solving skills.
• Experience with LOGIS, Waystar, or similar EMS billing/clearinghouse platforms is a plus.
• Experience in MS Office and general computer skills.

PHYSICAL REQUIREMENTS:

• Frequent use of reference manuals and payer resource materials.

MINIMUM QUALIFICATIONS:

• High School Diploma required; Associate's Degree preferred.
• Minimum of nine (9) months of experience in a medical office, EMS, or ambulance billing setting; prior ambulance/EMS eligibility verification experience preferred.
• This is a remote position. Texas residency required.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.

Allegiance is an EEO employer as defined by the EEOC.