Verification of Benefits & Authorization Specialist

Job description

**About Us** Happy Health is revolutionizing sleep medicine delivery through our comprehensive telehealth platform. We've eliminated the traditional barriers to sleep care – no more waiting months for appointments or spending uncomfortable nights in sleep labs. Our patients receive FDA-cleared home sleep testing via Happy Ring, connect with board-certified sleep specialists, and when required, begin evidence-based treatment within just 5 days. Ongoing physiological data monitoring with the Happy Ring enables real-time condition management, combination therapies, and drives measurable outcomes. **Happy Ring** represents the future of sleep diagnostics: an FDA-cleared medical device integrating advanced biometric sensors with AI-powered analysis to deliver highly accurate diagnostics and longitudinal management at home. For sleep medicine physicians, this means you'll have access to high-quality diagnostic data that empowers you to make confident clinical decisions for your patients, and integrate multimodal treatments that focus on root-cause solutions. **Position Summary** We are a growing Sleep Medicine practice seeking a detail-oriented Verification of Benefits & Authorization Specialist to join our team remotely. In this role, you'll serve as a critical link between our patients, providers, and insurance payers — verifying coverage, securing prior authorizations, and ensuring patients receive timely care without avoidable billing surprises or claim denials. The ideal candidate thrives on accuracy, knows their way around payer portals, and can juggle multiple authorization requests while keeping providers and patients informed every step of the way. **Key Responsibilities:** - Verify patient insurance eligibility and benefits (in-network and out-of-network) prior to scheduled appointments, procedures, and services via payer portals, clearinghouses, and phone - Obtain, track, and follow up on prior authorizations and retrospective authorizations for office visits, diagnostic testing, and procedures - Accurately document benefit details, authorization numbers, effective dates, and payer requirements in the practice management system / EHR - Calculate patient financial responsibility (copays, coinsurance, deductibles) to front-office staff and patients - Identify authorization requirements by payer and CPT code, and flag services at risk of denial before they are rendered - Monitor pending authorizations and proactively escalate delays that could impact patient care or scheduling - Collaborate with providers, clinical staff, schedulers, and billing to resolve coverage issues and reduce claim denials - Respond to authorization-related denials by gathering documentation and initiating appeals or retro-authorizations when appropriate - Stay current on payer policy changes, medical necessity criteria, and authorization workflows - Maintain compliance with HIPAA and all applicable privacy and security standards ### Required Qualifications - High school diploma or equivalent - Minimum of four (4) years of experience in insurance verification, prior authorization, retrospective authorizations or medical billing in a physician practice or outpatient setting - Working knowledge of commercial insurance, Medicare, and Medicaid plans, including HMO/PPO structures and authorization processes - Familiarity with CPT, ICD-10, and HCPCS coding as it relates to eligibility and authorization - Experience using payer portals (e.g., Availity) and practice management / EHR systems - Strong attention to detail, organization, and follow-through - Excellent written and verbal communication skills - Ability to work independently in a remote environment with reliable high-speed internet and a private, HIPAA-compliant workspace ### Preferred Qualifications - Bilingual (English/Spanish)