Benefits Specialist Jobs in California

Verification of Benefits Specialist

Position Title: Verification of Benefits Specialist
Department: Front Office / Billing
Reports To: Front Office Manager
FLSA Status: Non-Exempt
Schedule: Monday–Friday, 8:00 a.m.–5:00 p.m.
Starting Pay: $22.00 per hour

Position Summary

The Verification of Benefits Specialist is responsible for completing and managing the daily Verification of Benefits (VOB) process for all scheduled patient appointments at Fortuna Family Medicine. This position plays a critical role in ensuring patient eligibility and coverage requirements are verified before services are provided. Responsibilities include verifying primary and secondary insurance coverage, provider eligibility, PCP assignment, referral authorizations, Medi-Cal eligibility, patient balances, and required registration and self-pay documentation. The Specialist is expected to identify and work to resolve eligibility issues before the patient's appointment, maintain accurate documentation, and communicate clearly with patients and internal departments. This role requires exceptional attention to detail, accuracy, organization, and follow-through. Additional responsibilities include handling inbound and outbound patient calls and providing occasional front desk coverage for check-in and check-out.

Key Responsibilities

Verification of Benefits (Primary Responsibility)

● Complete the daily VOB process Monday through Friday for all scheduled patient appointments, following FFM's established Verification of Benefits Standard Operating Procedure.

● Take individual ownership of the VOB process. This is a designated responsibility and is not to be divided or delegated to other staff, except for temporary coverage during scheduled time off.

● Verify active, unrestricted primary and secondary insurance coverage for the date of service through the applicable payer portals and verification systems.

● Confirm that the patient's insurance coverage is eligible for the scheduled provider and verify Medicare Part B coverage when applicable.

● Verify Medi-Cal eligibility, aid code, share of cost (SOC), spend-down, and any coverage restrictions or limitations. Confirm the MSP status during verification of the eligibility.

● Confirm PCP assignment when required and verify referral authorizations, including authorization dates and encounter limits, in Athena Quickview and the patient chart.

● Review patient balances using the established Billing Department process and contact Billing when a balance is unclear or may be related to a pending insurance claim.

● Confirm that required New Patient Registration (NPR) forms, signatures, proof of legal authority when applicable, insurance cards, and identification are on file in Athena.

● Verify that applicable self-pay and Sliding Fee Scale (SFS) requirements are met and required documentation is on file.

● Identify potential eligibility or documentation issues early and take the necessary steps to resolve them before the patient's appointment whenever possible.

Problem Resolution & Documentation

● Contact patients, insurance plans, managed care plans, and other appropriate parties to resolve inactive coverage, PCP assignment issues, missing authorizations, missing documentation, and other eligibility concerns.

● Work to resolve identified issues the same day whenever possible and communicate any unresolved concerns to the appropriate staff member.

● Follow established procedures for managed care plan authorization issues, including requesting same-day or one-day authorization when appropriate and documenting authorization information in the patient chart.

● Maintain the daily VOB report in the designated FFM Google Drive document, organized by provider.

● Document the patient's name and chart number when follow-up is needed, along with the identified problem, action taken, resolution, and any remaining follow-up.

● Clearly communicate unresolved issues that may affect the patient's scheduled appointment so the appropriate team members are aware and prepared.

● Maintain supporting insurance verification documentation when required, including written verification received from insurance carriers.

Patient Communication & Phone Support

● Answer inbound calls and make outbound calls to patients in a timely, professional, and compassionate manner.

● Clearly explain insurance eligibility concerns, PCP assignment requirements, authorization needs, outstanding balances, and applicable self-pay or Sliding Fee Scale requirements within established clinic procedures.

● Assist patients with obtaining missing insurance information, registration forms, identification, and other required documentation prior to their appointments.

● Document patient communication and follow-up appropriately in Athena or the designated tracking document.

● Route questions or concerns outside the scope of the position to the appropriate department, supervisor, or manager.

Front Office Support

● Provide occasional coverage for front desk check-in and check-out as needed to support clinic operations.

● Assist with greeting patients, confirming appointment information, collecting required forms or payments, and completing check-in or check-out tasks according to established procedures.

● Maintain a professional and welcoming environment when interacting with patients and visitors.

Team Collaboration & Compliance

● Work closely with the Front Office Manager, Billing Department, Referrals Coordinator, and other clinic staff to resolve patient eligibility and coverage issues.

● Escalate complex or unresolved insurance, authorization, registration, or patient balance concerns to the appropriate manager or department.

● Maintain patient confidentiality and comply with HIPAA requirements, FFM policies, and established procedures at all times.

● Participate in department meetings, training, and periodic review of VOB procedures to maintain accuracy and consistency.

● Support overall clinic operations as needed while maintaining completion and accuracy of the primary VOB responsibilities.

Qualifications

Education & Experience

● High school diploma or equivalent required; additional education or training in medical office administration, billing, or healthcare operations preferred.

● Previous experience with medical billing, insurance eligibility and benefits verification, or insurance payer portals strongly preferred.

● Experience working in a medical office, healthcare setting, or patient services role preferred.

● Familiarity with electronic medical records; Athena experience preferred.

● Knowledge of Medicare, Medi-Cal, managed care plans, and medical insurance terminology preferred.

Skills & Abilities

● Exceptional attention to detail and accuracy, with the ability to identify discrepancies and recognize when information needs further verification.

● Strong organizational skills and the ability to independently manage a daily workload with consistent follow-through.

● Ability to prioritize time-sensitive tasks and complete VOB for all scheduled appointments within established timelines.

● Strong problem-solving skills and the ability to research and resolve insurance and eligibility issues.

● Clear, professional, and compassionate verbal and written communication skills.

● Ability to handle patient information with discretion and maintain strict confidentiality.

● Comfortable using multiple payer portals, computer systems, Google Workspace, and electronic medical records.

● Ability to work independently while communicating effectively and collaborating with the broader front office team.

Pay: $22.00 per hour

Expected hours: 40.0 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person