Verification Specialist

Description

Position Summary: 

The Verification (Verification of Benefits) Specialist plays a critical role in the financial clearance process for clients by verifying insurance benefits and communicating coverage details to relevant departments. This role is focused primarily on conducting thorough and timely VOBs for all levels of care and ensuring accurate insurance documentation in the EMR. The position also supports key administrative functions during lower volume periods and assists in maintaining the integrity of client insurance information throughout their treatment episode. 
 
Primary Duties and Responsibilities: 

Insurance Verification 

• Perform timely and accurate verification of benefits (VOBs) for all incoming clients across all levels of care (Detox, Residential, PHP, IOP, OP). 

• Confirm insurance coverage, benefit limitations, co-pays, deductibles, out-of-pocket maximums, exclusions, and pre-authorization requirements. 

• Accurately input VOB findings into designated tracking systems and update the client’s EMR face sheet with supporting documentation. 

• Communicate verified benefits clearly to the admissions, billing, and clinical teams to support smooth intake and ongoing care coordination. 
   

Ongoing Insurance Verification 

• Conduct bi-weekly re-verification of all active client insurance policies: 

• On the 1st of every month 

• Again on the 16th (or mid-month) 

• Identify and address any changes in coverage, lapses, or terminations promptly. 
   

COBRA & Marketplace Premium Tracking 

• Monitor and track COBRA and Marketplace premium payments for active clients who rely on these coverage types. 

• Communicate with clients or internal teams regarding lapses, pending payments, or terminations that may impact continued coverage or billing. 

• Maintain clear documentation of premium statuses and any outreach or action taken. 

General Duties 

• Complete special assignments and responsibilities as requested by supervisor. 

• Perform other duties as assigned. 

Secondary (As-Needed) Responsibilities – On Low Volume Days: 

• Audit client EMR face sheets for accurate and complete insurance information. 

• Enter client admission and discharge data into the billing system if Hybrid Billing Coordinator is unavailable or experiencing high volume. 

• Assist with initial claim follow-ups for basic issues such as eligibility denials or insurance coverage mismatches. 

Shared Responsibilities: 

• Upload VOB documentation to the client’s EMR face sheet (in collaboration with the Hybrid Billing/VOB Specialist). 

   

Preferred Skills & Qualifications: 

• Prior experience with insurance verification, preferably in a behavioral health or substance use treatment setting. 

• Strong understanding of commercial and government insurance policies, including pre-authorization processes and behavioral health benefits. 

• Familiarity with COBRA and Marketplace plans and their impact on ongoing treatment coverage. 

• Experience with EMR and billing systems. 

• Excellent attention to detail and organizational skills. 

• Effective verbal and written communication skills. 

• Ability to work independently and prioritize tasks in a fast-paced environment. 

• HIPAA compliance and respect for patient confidentiality.