Eligibility Verification & Authorization Specialist (Healthcare)

TL;DR

Eligibility Verification & Authorization Specialist (Healthcare): Managing health insurance verification and authorization processes for pediatric anxiety and OCD care with an accent on payer coordination and eligibility determination. Focus on optimizing the onboarding flow, navigating insurance 'red tape', and ensuring HIPAA compliance.

Location: Remote (USA)

Salary: $52,000–$55,000

Company

hirify.global provides specialty anxiety and OCD care for children and young adults by combining research-backed clinical care with innovative technology.

What you will do

• Verify insurance coverage using electronic systems, insurance websites, and direct calls to payers.
• Submit and manage authorization requests through payer portals and negotiate single case agreements.
• Determine patient eligibility by reviewing insurance policies, coverage limitations, and exclusions.
• Collaborate with billing, scheduling, and admissions teams to streamline enrollment and reimbursement.
• Resolve eligibility and coverage issues by working directly with insurance companies and patients.
• Maintain strict confidentiality of patient information in accordance with HIPAA regulations.

Requirements

• Minimum of 2 years of experience in an eligibility and authorization related role.
• Strong proficiency in using Availity for eligibility and authorization requests.
• Experience with Google Suite and electronic health record (EHR) systems.
• Deep understanding of the insurance landscape, policies, and authorization logistics.
• Knowledge of HIPAA regulations and patient confidentiality requirements.
• Must be based in the United States (implied by US-specific benefits and HIPAA requirements).

Culture & Benefits

• Comprehensive benefits including 401k with match and health insurance starting on day one.
• Flexible PTO, paid holidays, and paid service days.
• Generous leave policies: 4-week paid sabbatical and 12-week paid parental leave.
• Fully virtual work environment with periodic in-person retreats.
• Opportunity to work in a mission-driven environment focused on pediatric mental health.