Benefits Verification and Authorization Specialist

The BV&A Specialist is responsible for verifying patient insurance eligibility and benefits, obtaining necessary authorizations, and communicating requirements to providers. This role is essential to ensuring a smooth revenue cycle, preventing claim denials, and enhancing the overall patient financial journey.

Key Responsibilities

• Verify patient insurance coverage, eligibility, and benefits prior to services.
• Determine patient responsibility for copays, deductibles, and coinsurance.
• Obtain required prior authorizations from payers for services, procedures, or medications.
• Document benefit verification and authorization details accurately in the system.
• Collaborate with scheduling, billing, and AR teams to ensure accurate workflows.
• Communicate clearly, providers, and payers regarding authorization status.
• Monitor and track pending authorizations; follow up to prevent delays.
• Identify trends in benefit issues or authorization delays and escalate as needed.
• Support denial prevention efforts by ensuring all payer requirements are met upfront.

Minimum Requirements

• High school diploma or equivalent (Associate or Bachelor’s degree preferred).
• 1–2 years of experience in benefit verification, medical insurance, or prior authorization.
• Strong knowledge of commercial and government payers, insurance policies, and healthcare terminology.
• Excellent attention to detail and organizational skills.
• Strong communication skills with ability to work across patients, providers, and payers.

• Experience with RCM systems and EMRs
• Familiarity with payer authorization portals and workflows.
• Knowledge of denial management and insurance appeal processes.

Perks – What you can expect:

• Competitive salaries
• Remote/hybrid environment
• Potential equity compensation for outstanding performance
• Flexible PTO
• Company-wide sponsored lunches
• Company paid disability and life insurance benefits
• Company paid family and medical leave
• Medical, dental, and vision insurance benefits
• Discounted pet insurance
• FSA/DCA and commuter benefits
• 401k
• Credits for online and in-person fitness classes/gym memberships
• Recovery suite at HQ – includes a cold plunge, sauna, and shower