Insurance Eligibility And Verification Specialist – Behavioral Health

Insurance Eligibility and Verification Specialist – Behavioral Health

Employment Type: Full-Time

Job Summary

The Insurance Eligibility and Verification Specialist supports the behavioral health team by ensuring accurate insurance eligibility, benefit verification, and pre-authorizations for patients. The role requires expertise in behavioral health benefits, familiarity with payers in Pennsylvania (PA), New Jersey (NJ), Indiana (IN), Ohio (OH), Kentucky (KY), Minnesota (MN) and others; and the ability to communicate effectively with patients and providers to ensure seamless access to care.

Key Responsibilities

• Insurance Verification:
• Verify behavioral health benefits and coverage with commercial insurance, Medicaid, and managed care payers specific to PA, NJ, IN, OH, KY, MN and others.
• Confirm behavioral health-specific coverage details, including outpatient telehealth benefits.
• Pre-Authorization and Referrals:
• Obtain prior authorizations for behavioral health services, including therapy, psychiatry, and group therapy
• Ensure referral requirements are met for patients covered under HMO or managed Medicaid plans.
• Behavioral Health Focus:
• Understand and navigate mental health parity rules and ensure compliance with state-specific behavioral health coverage mandates.
• Patient Communication:
• Communicate with patients regarding behavioral health coverage limitations, out-of-pocket costs, and payer-specific rules for mental health services.
• Explain behavioral health pre-authorization requirements and assist in resolving patient concerns about insurance.
• Data Entry and Documentation:
• Accurately document payer communication, eligibility details, and authorization information in the electronic health record (EHR) or practice management system.
• Track behavioral health-specific eligibility issues and payer trends in PA, NJ, IN, OH, KY, MN and others.
• Collaboration and Coordination:
• Collaborate with behavioral health clinicians, schedulers, and billing teams to streamline patient workflows and reduce service delays.
• Act as a liaison between behavioral health providers and payers to resolve insurance-related issues efficiently.
• Compliance:
• Ensure compliance with HIPAA and state-specific payer regulations for behavioral health services.
• Stay informed about behavioral health-specific payer updates in PA, NJ, IN, OH, KY, MN and others.

Qualifications

• Education: High school diploma or equivalent required; associate degree in healthcare administration or related field preferred.
• Experience: Minimum of 2 years of insurance verification or medical billing experience, with a focus on behavioral health preferred.
• Skills:
• Knowledge of behavioral health benefits, CPT codes, and ICD-10 diagnosis codes specific to mental health services.
• Familiarity with major payers and Medicaid plans in PA, NJ, IN, OH, KY, and MN.
• Proficiency in EHR systems and payer portals.
• Strong attention to detail and ability to manage high volumes of verifications.
• Excellent written and verbal communication skills.

Preferred Qualifications

• Certification in medical billing and coding (e.g., CPC, CCA, or equivalent).
• Experience with Medicaid and managed care behavioral health plans.
• Understanding of mental health parity laws and state-specific behavioral health coverage regulations.

Job Type: Full-time

Pay: $18.51 - $24.30 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: Remote