Insurance Verification Specialist

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FamilyWell Health

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Healthcare Insurance • Healthcare • Wellness

FamilyWell Health is a healthcare company that specializes in providing integrated behavioral health services for pregnant and postpartum individuals. By incorporating mental health support into obstetric practices, FamilyWell aims to address the significant number of women experiencing perinatal mental health issues. The company's services are covered by insurance, allowing obstetric clinics to offer easily billable care while improving patient outcomes through timely access to mental health resources and support.

11 - 50 employees

Founded 2022

⚕️ Healthcare Insurance

🧘 Wellness

📋 Description

• Verify patient insurance eligibility and behavioral health benefits for all new and existing patients. • Confirm coverage for therapy, psychiatry, coaching (when applicable), and Collaborative Care (CoCM) codes 99492–99494. • Determine plan type (commercial, Medicaid/MCO, Medicare/Advantage, HMO/PPO) and in/out-of-network status. • Identify high-deductible plans and flag accounts requiring patient cost-share counseling. • Verify secondary insurance when applicable. • Enter accurate benefit details in Healthie, including deductibles, copays, coinsurance, authorization notes, and portal findings. • Ensure all benefit information is complete, consistent, and documented prior to the patient's appointment. • Maintain internal benefit verification logs and update payer-specific notes as needed. • Communicate directly with patients when coverage issues arise, such as inactive plans or high cost-share amounts. • Collaborate with billing, credentialing, and patient collections to ensure a smooth revenue cycle and minimize denials. • Work closely with OB/GYN partner clinics to confirm referral diagnoses, dates of service, and PA requirements. • Escalate benefit discrepancies, payer issues, or unclear coverage to the RCM leadership team. • Maintain a high level of accuracy and thoroughness in all insurance verifications. • Stay current on payer updates, plan changes, and multi-state coverage nuances. • Protect patient information in compliance with HIPAA and FamilyWell policies. • Support ongoing process improvements and participate in RCM team huddles as needed.

🎯 Requirements

• High school diploma or GED required; Associate’s or Bachelor’s degree in health administration, business, healthcare management or related field preferred. • Minimum 2-3 years of experience in healthcare provider services, prior authorization, utilization management, provider access or RCM in a multi-payer environment. • Strong working knowledge of insurance eligibility, authorizations, CPT/HCPCS codes, payer policies (especially behavioral health/CoCM), and EMR/authorization workflow systems. • Experience with payer types including Medicaid MCOs, FFS, Medicare Advantage and commercial insurers. • Experience working in a behavioral health or women’s health setting is a strong plus. • Excellent organizational, time-management and documentation skills; ability to track multiple authorization requests in parallel and follow through to completion. • Strong communication skills – able to interact with payers, providers, internal teams and patients in a clear and professional manner. • Detail-oriented and proactive. Able to identify missing documentation or authorizations before service delivery to prevent denials. • Analytical mindset – comfortable reviewing authorization/denial data, identifying trends, and recommending process improvements. • Ability to translate technical payer policy/authorization requirements into clear internal SOPs and patient-facing communications (consistent with your preference for ready-to-use templates).

🏖️ Benefits

• Be part of a mission-driven organization tackling women’s mental health and making a meaningful difference across fertility to menopause. • Collaborate with a dynamic, embedded team model (care managers, therapists, psychiatrists, OB/GYN partners) that values operational excellence and patient experience. • Opportunity to build and improve processes, documentation, and workflows—leveraging your strengths in SOP creation, training and high-impact coordination. • Growth opportunity as the organization expands services, payer panels, and geographies.