Children’s Eye Center of El Paso is seeking a dependable, detail-oriented Insurance Verification Specialist to join our busy pediatric ophthalmology practice. This position plays an essential role in ensuring patients are properly scheduled, benefits are verified accurately, and authorization requirements are addressed before services are provided.
The ideal candidate is organized, comfortable working with multiple insurance plans, and able to communicate clearly and professionally with insurance representatives, patients’ families, and clinic staff.
Primary Responsibilities
- Verify eligibility, benefits, and coverage before scheduled appointments and procedures.
- Confirm copays, deductibles, coinsurance, referral requirements, plan exclusions, and other patient responsibilities.
- Obtain and track referrals and prior authorizations when required.
- Verify medical and vision benefits and determine which coverage applies to the scheduled service.
- Review insurance cards and confirm that patient and policy information is complete and accurate.
- Identify HMO, Medicaid, managed-care, commercial, self-pay, and other payer requirements.
- Confirm that the scheduled provider and facility are in network.
- Document verification details clearly and accurately in the patient’s account.
- Notify scheduling and billing staff promptly of coverage concerns, authorization issues, or services that may not be covered.
- Contact parents or guardians when updated insurance information, referrals, or additional documentation is needed.
- Monitor upcoming appointments to ensure verification is completed within required timeframes.
- Assist with resolving eligibility discrepancies and insurance-related scheduling concerns.
- Maintain patient confidentiality and comply with HIPAA requirements.
- Work closely with the billing, scheduling, front-office, and clinical teams to prevent avoidable denials and delays in care.
Qualifications
- Previous medical insurance verification experience is required.
- Experience in a medical office, specialty practice, or healthcare billing environment is preferred.
- Knowledge of eligibility, benefits, referrals, prior authorizations, copays, deductibles, coinsurance, and payer requirements.
- Familiarity with Texas Medicaid managed-care plans, commercial insurance, HMOs, and vision plans is a plus.
- Experience with Availity and insurance payer portals is preferred.
- Strong attention to detail and ability to recognize discrepancies before they affect patient care or billing.
- Ability to manage a high-volume workload while meeting daily deadlines.
- Strong written and verbal communication skills.
- Professional and patient when communicating with families and insurance representatives.
- Bilingual English/Spanish is highly preferred.
- Dependable attendance and the ability to work effectively as part of a team are required.