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Home Health Insurance Verification Specialist - Investigator at Everforth: 100% Remote (US)
Title: PT Home Health Insurance Verification Specialist/Investigator
Location: United States
remote
Job Description:
Part Time Home Health Insurance Verification Specialist
1 year contract
100% Remote
20 hours per week, M-F either 8am-12pm OR 9am-1pm
Position Summary
We are seeking an experienced Home Health Insurance Verification Specialist to support insurance eligibility, benefits verification, authorization review, and payer validation activities throughout the patient care lifecycle. This individual will play a critical role in ensuring accurate reimbursement, timely admissions, regulatory compliance, and uninterrupted patient care by validating insurance coverage and payer requirements across a variety of government and commercial health plans.
This role requires a strong understanding of healthcare insurance verification processes, payer guidelines, reimbursement requirements, and the ability to collaborate effectively with both operational and clinical teams.
Key Responsibilities
- Perform comprehensive insurance eligibility and benefits verification prior to admission and throughout the patient care lifecycle.
- Verify Medicare, Medicare Advantage, Medicaid, Medicaid Managed Care, commercial insurance, hospice coverage, self-pay accounts, and specialty program eligibility.
- Review payer-specific requirements, authorization requirements, coverage limitations, and reimbursement methodologies.
- Utilize Epic and multiple payer portals to validate coverage, eligibility, and authorization status.
- Determine primary and secondary payer responsibility and ensure accurate billing pathways.
- Research and resolve insurance discrepancies, coverage changes, policy terminations, and authorization issues.
- Document verification findings and payer communications accurately within the EMR.
- Monitor and manage assigned work queues to ensure timely completion of verification activities.
- Partner with clinicians, case managers, and operational teams regarding coverage, eligibility, and reimbursement impacts.
- Identify reimbursement risks and proactively communicate concerns to appropriate stakeholders.
- Support audits, compliance efforts, and payer-related investigations as needed.
- Maintain productivity, quality, and accuracy standards while managing a high-volume workload.
Required Qualifications
- 3+ years of healthcare insurance verification, patient access, revenue cycle, or related healthcare operations experience.
- Epic experience.
- Experience verifying Medicare, Medicaid, Medicare Advantage, and commercial insurance plans.
- Strong understanding of insurance eligibility, benefits verification, authorizations, and reimbursement processes.
- Experience working with payer portals and eligibility verification tools.
- Exceptional attention to detail and commitment to accuracy.
- Strong communication and customer service skills.
- Ability to work independently in a remote environment.
- Strong organizational and problem-solving skills.
Preferred Qualifications
- Home Health insurance verification experience.
- Home Health revenue cycle experience.
- Knowledge of Home Health billing regulations and reimbursement requirements.
- Experience supporting admissions, recertifications, and episode management workflows.
- Experience collaborating with nurses, case managers, clinicians, and care coordination teams.
- LPN, RN, Patient Access, Insurance Verification, or Revenue Cycle background.
Skills & Competencies
- Healthcare insurance verification
- Eligibility and benefits validation
- Authorization management
- Revenue cycle operations
- Medicare and Medicaid knowledge
- Epic EMR
- Payer portal navigation
- Compliance and documentation
- Critical thinking and problem solving
- Stakeholder communication
- Time management and prioritization
EEO Employer
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178.
Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing in Talent Satisfaction in the United States and Great Place to Work in the United Kingdom and Mexico.
Everforth Apex uses a virtual recruiter as part of the application process. Click here for more details. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Everforth Apex and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help.
Everforth Apex Benefits Overview: Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Everforth Apex team member can provide.
Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.
UnitedHealthcare creates and publishes the Transparency in Coverage Machine-Readable Files on behalf of Everforth Apex Systems.
Employee Type:
Contract
Remote:
Yes
Job Type:
Pay Range:
$20 - $23 per hour
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