About the insurance verification role
Eligibility denials are the easiest denials to prevent and among the most common. Coverage changes, plans terminate, a secondary becomes primary, and nobody notices until the claim comes back. As an eligibility and benefits verification specialist you check before the visit, so the front desk knows what to collect and the claim goes to the right payer.
What you will do
- Verify active coverage for scheduled patients ahead of their appointments
- Confirm benefits for the service type: copay, coinsurance, deductible met, visit limits
- Check whether the service needs prior authorization or a referral and hand it off
- Identify coordination-of-benefits issues and the correct primary payer
- Update demographics and insurance details in the practice management system
- Flag out-of-network and inactive coverage to the practice before the visit
- Note behavioral health carve-outs and plan-specific mental health benefits
What you need
- One or more years of insurance verification, patient access or front-end billing
- Experience with payer portals, Availity and real-time eligibility (270/271) tools
- Understanding of HMO, PPO, EPO, Medicare Advantage and Medicaid managed care plans
- Speed with accuracy — schedules are long and visits are close
Working remotely at CredSpun
This is a fully remote, work-from-home role open to applicants living in the United States. You work during U.S. business hours alongside a named account team, inside each client practice's own EHR and practice management system, with every login tied to you personally. You need a quiet, private workspace, a reliable broadband connection and a computer that can run a current browser and a second monitor. HIPAA training is part of onboarding, and you sign our confidentiality terms before you are given access to any patient data.