[Hiring] Medical Insurance Billing & Verification Specialist @Somewhere

Role Description

This hire is driven by volume and growth. As we scale, we need a billing specialist to independently own insurance verification, authorization, and the full denial and pending-claims follow-up for a defined region of our clinics.

This is its own corner of the business. Ownership of the workflow sits squarely with this person — but they are not on an island. They work inside a collaborative team with support, written resources, and documented processes to lean on. This is not a train-from-scratch role. You should already know how to verify benefits, post payments, and work denials; what we'll teach you is our systems and our nuances (including Florida PIP). We're looking for someone who ramps quickly and takes real ownership from the start.

Key Responsibilities

• Insurance Verification & Eligibility
  • Verify patient health insurance eligibility and benefits, and serve as backup coverage for the primary verifier when needed
  • Confirm deductibles, copayments, coinsurance, and coverage limitations
  • Determine in-network and out-of-network benefits
  • Document insurance details accurately in the system
• Authorization & Referral Management
  • Submit authorizations and referrals when required
  • Track authorization approvals, denials, and expiration dates
  • Coordinate with the treating offices on approved visits and services
• Claims Follow-Up & Denial Management
  • Own the full denial and pending-claims follow-up workflow for the assigned region of clinics
  • Investigate, correct, and resubmit denied and rejected claims through resolution
  • Identify recurring denial patterns and flag process issues that affect collections
• Payment Posting & Reconciliation Support
  • Research and locate insurance payments as requested by the posting team
  • Support reconciliation of posted payments against expected reimbursement
• Patient & Cash Account Management
  • Identify and update patient accounts tied to cash/self-pay programs
  • Keep account statuses accurate across insurance and self-pay activity

Qualifications

• Prior medical billing experience in a U.S. healthcare setting
• Demonstrated experience following up on and resolving denied and pending claims
• Insurance payment posting experience
• Proven ability to independently own a billing workflow with limited oversight
• Strong written and spoken English
• Reliable full-time overlap with U.S. Eastern business hours

Ideal Candidate Profile

• Highly organized and detail-driven, and accurate even at high claim volume
• Self-directed — you take ownership and move work forward without being managed task-to-task
• Quick to ramp on new systems and comfortable learning practice-specific nuances
• Steady across a mix of payer types (commercial, PIP, workers' comp, self-pay)
• Collaborative — you use your team as a resource without needing hand-holding
• Dependable and consistent, the kind of person a lean team can trust with a whole region

Benefits

• You're stepping into a defined, well-supported role — not building the plane while flying it.
• There are documented SOPs, real onboarding, and a training period to get you fully up to speed, inside an established and growing ten-location group.
• You'll own a meaningful piece of the business with the support of a collaborative team behind you.