About FamilyWell Health

FamilyWell Health is on a mission to transform women’s mental health across the reproductive life-span (fertility → perinatal → menopause) by embedding evidence-based, insurance-covered care into OB/GYN practices and health systems. FamilyWell Health. As part of the RCM/Operations team, the Prior Authorization Specialist will play a key role in ensuring that care is authorized, reimbursed, and seamlessly delivered, reducing friction for patients and providers alike.

Job Title

Insurance Verification Specialist

Department

Revenue Cycle / Provider Access & Authorization

Reports to: Director of RCM / Provider Access

Location: Remote

Role Overview

The Insurance Verification Specialist verifies patient insurance benefits, coverage limitations, and prior authorization requirements for all behavioral health and CoCM services. They ensure accurate documentation in Healthie and communicate relevant information to billing and clinical teams. This role is essential in reducing denials, improving patient financial transparency, and supporting smooth RCM operations.

Key Responsibilities

Insurance Verification & Eligibility

• Verify patient insurance eligibility and behavioral health benefits for all new and existing patients.
  
  
• Confirm coverage for therapy, psychiatry, coaching (when applicable), and Collaborative Care (CoCM) codes 99492–99494.
  
  
• Determine plan type (commercial, Medicaid/MCO, Medicare/Advantage, HMO/PPO) and in/out-of-network status.
  
  
• Identify high-deductible plans and flag accounts requiring patient cost-share counseling.
  
  
• Verify secondary insurance when applicable.
  
  

Benefit Documentation

• Enter accurate benefit details in Healthie, including deductibles, copays, coinsurance, authorization notes, and portal findings.
  
  
• Ensure all benefit information is complete, consistent, and documented prior to the patient's appointment.
  
  
• Maintain internal benefit verification logs and update payer-specific notes as needed.
  
  

Communication & Collaboration

• Communicate directly with patients when coverage issues arise, such as inactive plans or high cost-share amounts.
  
  
• Collaborate with billing, credentialing, and patient collections to ensure a smooth revenue cycle and minimize denials.
  
  
• Work closely with OB/GYN partner clinics to confirm referral diagnoses, dates of service, and PA requirements.
  
  
• Escalate benefit discrepancies, payer issues, or unclear coverage to the RCM leadership team.
  
  

Quality Assurance & Compliance

• Maintain a high level of accuracy and thoroughness in all insurance verifications.
  
  
• Stay current on payer updates, plan changes, and multi-state coverage nuances.
  
  
• Protect patient information in compliance with HIPAA and FamilyWell policies.
  
  
• Support ongoing process improvements and participate in RCM team huddles as needed.

Qualifications

Education & Experience

• High school diploma or GED required; Associate’s or Bachelor’s degree in health administration, business, healthcare management or related field preferred.
  
  
• Minimum 2-3 years of experience in healthcare provider services, prior authorization, utilization management, provider access or RCM in a multi-payer environment.
  
  
• Strong working knowledge of insurance eligibility, authorizations, CPT/HCPCS codes, payer policies (especially behavioral health/CoCM), and EMR/authorization workflow systems.
  
  
• Experience with payer types including Medicaid MCOs, FFS, Medicare Advantage and commercial insurers.
  
  
• Experience working in a behavioral health or women’s health setting is a strong plus.
  
  

Skills & Competencies

• Excellent organizational, time-management and documentation skills; ability to track multiple authorization requests in parallel and follow through to completion.
  
  
• Strong communication skills – able to interact with payers, providers, internal teams and patients in a clear and professional manner.
  
  
• Detail-oriented and proactive. Able to identify missing documentation or authorizations before service delivery to prevent denials.
  
  
• Analytical mindset – comfortable reviewing authorization/denial data, identifying trends, and recommending process improvements.
  
  
• Ability to translate technical payer policy/authorization requirements into clear internal SOPs and patient-facing communications (consistent with your preference for ready-to-use templates).
  
  
• Comfort working in a remote environment and collaborating across teams (credentialing, billing, care management, operations).
  
  

Measures of Success

Accuracy & Quality

• 95%+ accuracy rate in documenting insurance benefits and coverage details in Healthie.
  
  
• Zero preventable claim denials due to incorrect eligibility, coverage, or missing authorization information.
  
  
• Consistently complete and clear benefit notes that support downstream billing and patient collections workflows.
  
  

Turnaround Time

• Insurance verification for all new patients completed within 24–48 hours of referral or scheduling.
  
  
• Urgent/same-day verifications completed before scheduled appointment time.
  
  
• Prior authorization requirements identified prior to service, preventing delays or retroactive requests.
  
  

Communication & Collaboration

• Effective communication with RCM, clinical teams, and OB/GYN partner practices, with minimal need for clarification or rework.
  
  
• Timely notifications to patients regarding inactive coverage, high-deductible plans, or missing insurance information.
  
  
• Proactive escalation of payer issues, unclear benefits, or recurring trends affecting workflow.
  
  

Operational Efficiency

• Demonstrated ability to manage daily verification queue while supporting multi-state operations.
  
  
• Clear documentation standards that contribute to streamlined billing, reduced patient confusion, and improved financial transparency.
  
  
• Contribution to improved clean claim rate and reduced A/R delays tied to front-end issues.
  
  

Professionalism & Compliance

• Consistent adherence to HIPAA, FamilyWell policies, and payer requirements.
  
  
• Active participation in RCM huddles, audits, or workflow improvement initiatives.
  
  
• Reliable attendance, accountability, and follow-through on assigned verifications and tasks.
  
  

Working Conditions & Location

• Remote
  
  
• Standard business hours; occasional ad-hoc follow-up with payers or provider offices may require flexibility.
  
  
• Work is primarily desk/PC-based but requires regular phone/email/payer portal interactions.
  
  

Why Join FamilyWell

• Be part of a mission-driven organization tackling women’s mental health and making a meaningful difference across fertility to menopause.
  
  
• Collaborate with a dynamic, embedded team model (care managers, therapists, psychiatrists, OB/GYN partners) that values operational excellence and patient experience.
  
  
• Opportunity to build and improve processes, documentation, and workflows—leveraging your strengths in SOP creation, training and high-impact coordination.
  
  
• Growth opportunity as the organization expands services, payer panels, and geographies.