Insurance Verification Specialist
About the role
About Bluebird Kids Health
Bluebird Kids Health is a dynamic organization that provides underserved communities with new access to value-based pediatric primary care. We are on a mission to provide exceptional care, so every child can thrive.
General Job Summary
Primary responsibilities include reviewing patient insurance eligibility issues in advance of scheduled visits across all practice sites; identifying and resolving insurance issues before they can disrupt a visit or delay claims submission; and serving as the connective link between our central patient scheduling teams, our practice-based teams, and the billing team on all insurance- and eligibility-related questions.
Essential Job Responsibilities
- Reviews insurance eligibility and coverage issues across practice sites for new and existing patient appointments three (3) days out (leveraging automated eligibility checks from our Electronic Health Record (EHR) system).
- Reaches out to payers (e.g., via phone or payer portal) and communicates proactively with families to resolve insurance issues prior to a visit. Flags open issues for practice teams for follow-up on day of visit.
- Serves as the primary escalation contact for the central operations scheduling team on pre-visit insurance and eligibility issues.
- Serves as the main point of contact for practice-based teams (e.g., reception) on day-of-visit insurance eligibility questions.
- Follows up post-visit on lingering primary care provider (PCP) assignment issues and Coordination of Benefits (COB) discrepancies with payers and patients/families.
- Ensures pertinent information relating to patient insurance and eligibility is documented accurately in the EHR.
- Works with front desk/reception staff to ensure appropriate collection of co-pay and self-pay fees based on verified benefits.
- Uses customer service principles and techniques to deal with patients calmly and pleasantly and assist with insurance-related questions or issues.
- Identifies trends in recurring eligibility, PCP assignment, or COB issues across sites and communicates them to leadership.
- Maintains strict confidentiality; adheres to all HIPAA guidelines/regulations.
- Performs other duties as assigned.
Education
High school diploma or equivalent with excellent computer skills.
Experience
Insurance verification, medical billing, or other relevant healthcare practice experience required (preference for primary care).