Job Details

Pre-Verification Specialist / Charge Review Specialist

The Pre-Verification Specialist/Charge Review Specialist is responsible for ensuring accurate insurance verification, coverage validation, and claim readiness prior to and following patient visits. This role serves as a key resource for clinics regarding insurance-related questions and works closely with patients, insurance carriers, and internal departments to ensure accurate billing and reimbursement.

Essential Responsibilities

Pre-Verification Functions

• Verify patient insurance coverage for scheduled appointments at least four days prior to service dates.
• Review and process accounts that are not already in a verified status within the work queue (WQ).
• Contact patients and insurance carriers to obtain and confirm eligibility, benefits, and coverage information.
• Ensure the correct insurance plans are loaded in the patient account and make necessary corrections when discrepancies are identified.
• Serve as the assigned insurance resource for designated clinics, providing support and answering insurance-related questions.
• Document verification activities and updates accurately within the appropriate systems.

Charge Review Functions

• Review and resolve insurance-related errors that populate in the work queue after patient visits.
• Contact insurance carriers to verify active coverage and confirm accurate insurance information.
• Update patient accounts with correct insurance coverage and demographic information as needed.
• Correct claim filing orders to ensure claims are billed to the appropriate payer in the correct sequence.
• Communicate with patients to obtain updated insurance information when required.
• Collaborate with billing, clinic, and revenue cycle teams to resolve claim and coverage issues efficiently.
• Maintain compliance with organizational policies, payer requirements, and applicable regulations.

Required Skills and Qualifications

• Knowledge of health insurance verification, benefits, eligibility, and payer guidelines.
• Understanding of medical billing processes, claim filing procedures, and coordination of benefits.
• Strong attention to detail and problem-solving skills.
• Excellent verbal and written communication skills.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Proficiency with electronic medical records (EMR), practice management systems, and work queues.
• Customer service experience and the ability to professionally interact with patients, providers, and insurance representatives.

Preferred Qualifications

• Experience in healthcare administration, patient access, insurance verification, medical billing, or revenue cycle management.
• Familiarity with Medicare, Medicaid, and commercial insurance plans.
• Knowledge of claim edits, denials management, and insurance filing requirements.

Key Competencies

• Accuracy and attention to detail
• Customer service
• Communication skills
• Time management
• Problem-solving
• Team collaboration
• Insurance and billing expertise

At Novant Health, we believe remarkable care starts with compassion for our patients, our communities, and each other. We value belonging, courage, personal growth, and teamwork, creating a space where everyone is respected, supported, and safe to show up as their full selves.

Job Opening ID 198113