Insurance Verification & Patient Financial Clearance Specialist

• Location: Remote
• Company: eddii, Inc. / eddii-Care
• Engagement: Part-Time Contractor
• Travel: 0%

eddii-Care is a virtual endocrinology specialty clinic providing innovative, compassionate care for people living with diabetes and other endocrine conditions.

We are seeking an experienced Insurance Verification & Patient Financial Clearance Specialist to ensure patients are financially cleared for care before their appointments and to manage insurance-related requirements, including prior authorizations.

Position Overview

The Insurance Verification & Patient Financial Clearance Specialist will verify patient eligibility and benefits, determine expected patient responsibility, communicate costs to patients before their visits, and resolve insurance issues that could prevent or delay care.

This person will also own prior authorization workflows, working with payers and the clinical team to obtain approvals when required.

We are looking for someone who is proactive, detail-oriented, persistent, and comfortable calling insurance companies when information cannot be resolved through payer portals.

Key Responsibilities

• Verify insurance eligibility and benefits before patient appointments.
• Confirm active coverage, network status, and benefits applicable to eddii's services.
• Determine copays, coinsurance, deductibles, and other expected patient responsibility.
• Proactively communicate expected financial responsibility to patients before their appointments.
• Identify referral, authorization, or other payer requirements that could affect coverage.
• Prepare, submit, and track prior authorization requests.
• Follow up with payers on pending prior authorizations and resolve requests for additional information.
• Coordinate with clinical staff when documentation or clinical information is required for authorization.
• Use payer portals and eligibility tools to research coverage and benefits.
• Call insurance companies when benefit information is incomplete, inconsistent, or unclear.
• Resolve insurance discrepancies and obtain updated information from patients when needed.
• Document verification results, authorization status, patient responsibility, and follow-up activity accurately.
• Maintain a clear work queue of unresolved insurance and authorization issues.
• Collaborate with scheduling, billing, and clinical teams to prevent insurance-related delays or billing surprises.

Qualifications

• 2+ years of experience in insurance verification, patient access, financial clearance, prior authorization, or related healthcare operations.
• Hands-on experience verifying medical insurance eligibility and benefits.
• Experience determining copays, deductibles, coinsurance, and patient financial responsibility.
• Experience communicating directly with commercial payers, Medicare, and/or Medicaid.
• Experience using payer portals and calling insurance companies to resolve coverage questions.
• Strong attention to detail and follow-through.
• Strong patient communication skills, including the ability to explain financial responsibility clearly and professionally.
• Ability to independently manage multiple open cases and follow them through resolution.
• Ability to work independently in a remote environment.

Preferred Qualifications

• Experience managing medical prior authorizations.
• Experience with Medicare Advantage, Medicaid managed care, or dual-eligible populations.
• Experience with telehealth, endocrinology, diabetes care, or specialty medical practices.
• Experience working with multiple payers and plans.
• Familiarity with EHR, eligibility, payer portal, and practice-management systems.
• Experience in a startup or high-growth healthcare environment.

What Success Looks Like

Success means insurance issues are identified and addressed before they become problems on the day of the appointment or after a claim is submitted.

The right person will help ensure

• Patients are verified before their appointments.
• Expected patient responsibility is identified and communicated in advance.
• Prior authorization requirements are identified early.
• Authorizations are submitted and followed through to resolution.
• Coverage discrepancies have a clear next action.
• Scheduling and billing teams have accurate insurance information.
• Patients experience fewer unexpected bills or insurance-related disruptions.

Key measures may include

• Percentage of patients verified before their appointment.
• Percentage of expected patient responsibility communicated in advance.
• Prior authorization submission and approval turnaround time.
• Percentage of authorization requests followed up on within required timelines.
• Number of appointments affected by unresolved insurance issues.
• Accuracy of insurance and financial clearance information.
• Zero unresolved cases becoming stale without a clear next action.



Why Join eddii

• Flexible remote contractor role.
• Competitive compensation.
• Opportunity to build and improve insurance and financial-clearance workflows as we grow.
• Work with a mission-driven team improving care for people living with diabetes and other chronic conditions.