Internal Job Title: Eligibility and Verification Specialist

Type of Employment: Full Time

Schedule: 40 hours per week, Pacific Time

Job Level: Mid-Level

Who We Are

The client is a private orthopedic and sports medicine practice based in Las Vegas, Nevada. The company provides surgical and non-surgical treatments for joint, muscle, and sports-related injuries, along with services like joint replacement, regenerative medicine, and diagnostic imaging. It focuses on personalized, patient-centered orthopedic care for active adults and athletes. The practice is led by orthopedic surgeons and operates independently rather than as part of a large hospital system.

Who You Are

We are looking for a detail-oriented Eligibility and Verification Specialist to join our growing team. In this role, you will be responsible for verifying patient insurance eligibility, ensuring accurate payer information, and supporting clean claim submissions to minimize billing delays and denials.

You are organized, analytical, and comfortable working with payer portals, insurance verification systems, and healthcare billing workflows. You thrive in a fast-paced environment and communicate effectively with internal teams, insurance companies, and patients when necessary.

What You'll Do

Perform insurance eligibility verification for all scheduled patients prior to service
Review patient insurance cards and accurately extract:
- Member ID
- Group number
- Payer details
- Plan type and coverage specifics
Verify benefits through:
- Insurance portals
- Clearinghouses
- Direct payer websites
- Phone calls to insurance companies or patients when needed
Identify and document:
- Active/inactive coverage
- Deductibles, co-pays, and co-insurance
- Referral or authorization requirements
Ensure correct payer ID selection for claim submission
Flag discrepancies and communicate proactively with front desk or billing teams
Investigate and resolve eligibility-related claim rejections and issues
Re-verify eligibility for high-risk or previously denied claims
Maintain accurate and detailed documentation in billing/EMR systems
Stay current on payer-specific rules, policies, and updates

What We're Looking For

2+ years of experience in U.S. medical billing and insurance verification
Strong knowledge of:
- Commercial insurance, Medicare, and Medicaid
- Payer portals and eligibility tools
- Claim workflows and clearinghouses
- Authorization and referral workflows
Ability to interpret insurance cards and determine correct payer routing
Experience handling eligibility-related issues and claim rejections
Comfortable making outbound calls to U.S. insurance companies and patients
Strong attention to detail and organizational skills
Excellent communication and documentation abilities
Experience with EMR/EHR and billing systems preferred

Hiring Process

Initial screening call with Flexscale: A brief conversation to walk through your background, experience, and role alignment.
Interview with the client: Meet key stakeholders to discuss your experience, skills, and how you approach the role.
Final interview with the client: A deeper conversation focused on long-term fit, expectations, and next steps.