Benefit Verification Specialist

Why Join Us? We are seeking talented, compassionate, and highly motivated individuals who are passionate about making a difference. At Carolina Oncology Specialists, you'll have the opportunity to support the meaningful work of community oncology while helping provide exceptional care and hope to the patients and families we serve. Join a team dedicated to clinical excellence, collaboration, and improving lives every day.

Job Title: Benefit Verification Specialist

Department: RCM

Location: Carolina Oncology Specialists-TBD

Reports To: Billing Manager

Position Summary: The Benefit Verification Specialist is responsible for verifying patient insurance eligibility, benefits, and coverage prior to services being rendered. This role ensures accurate and timely benefit information to support patient care, financial counseling, and billing processes. The Benefit Verification Specialist plays a critical role in reducing claim denials, improving reimbursement outcomes, and enhancing the patient financial experience.

Key Responsibilities: Verify patient insurance eligibility and benefits for all scheduled services Confirm coverage details including copays, deductibles, coinsurance, out-of-pocket maximums and network status Communicate benefit and coverage details to financial counselors, billing teams, and clinical staff Document all verification details accurately in the electronic health record (EHR) or practice management system Review payer responses to ensure completeness and accuracy of information obtained Work closely with scheduling, financial counseling, and prior authorization teams to ensure timely financial clearance Identify discrepancies in insurance coverage and resolve issues prior to services Notify patients or appropriate staff of coverage limitations, out of network status or potential financial responsibility Maintain knowledge of payer policies including Medicare, Medicaid, and commercial insurance plans Ensure compliance with HIPAA and organizational policies when handling patient information Assist in identifying trends in coverage issues or verification delays and escalate to leadership

Required: High school diploma or equivalent Minimum of 2-3 years of experience in patient access, insurance verification, or revenue cycle operations Knowledge of insurance plans including Medicare, Medicaid, and commercial payers Experience with EHR and practice management systems Strong attention to detail and organizational skills Excellent communication and customer service skills

Preferred: Experience in oncology or specialty healthcare setting Familiarity with prior authorization and financial counseling workflows Knowledge of payer portals and eligibility verification tools

Key Competencies: High attention to detail and accuracy Strong analytical and problem-solving skills Effective communication and collaboration Time management and ability to meet deadlines Ability to manage multiple priorities in a fast-paced environment Patient-focused and service-oriented mindset Accountability and reliability

Working Conditions: Primarily office-based or patient access environment Frequent interaction with staff, patients, and insurance payers Regular use of computers, phones, and payer systems

Physical Requirements: Ability to sit for extended periods Ability to use standard office equipment, including computers and telephones