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ASCENSION is seeking an experienced Senior Medical Insurance Verification Specialist to support nationwide healthcare insurance entry and verification operations for the U.S. Department of Veterans Affairs, Veterans Health Administration, Consolidated Patient Account Center Revenue Operations.

We are seeking a healthcare revenue-cycle professional who understands that accurate insurance information is not simply an administrative transaction. It directly supports the VA’s ability to maintain reliable patient insurance records, coordinate third-party benefits, resolve insurance discrepancies, and support reimbursement for eligible care provided to Veterans.

The ideal candidate combines medical insurance verification expertise, exceptional attention to detail, payer research skills, healthcare data accuracy, problem-solving ability, and disciplined production performance. This individual should be comfortable working independently in a high-volume remote production environment while adhering to defined processing deadlines, quality standards, HIPAA requirements, VA privacy requirements, and established operating procedures.

This is a senior production role with secondary responsibilities as a complex-policy resource, rejection-resolution specialist, peer coach, and backup quality reviewer. The individual may help less experienced specialists interpret difficult insurance situations and correct processing issues. However, the Senior Medical Insurance Verification Specialist will not approve or perform the final independent quality acceptance of their own transactions.

The VA’s objective is accurate, timely, and compliant establishment, verification, updating, and maintenance of third-party insurance information across CPAC operations nationwide. Contractor performance is subject to measurable standards and Government quality surveillance.

Position Summary

The Senior Medical Insurance Verification Specialist performs production-level insurance entry, eligibility verification, policy maintenance, payer research, discrepancy resolution, and coordination-of-benefits activities involving medical and prescription insurance policies.

The specialist will research insurance information through authorized VA healthcare applications, payer/provider portals, and other Government-approved information sources; determine whether coverage information is accurate and current; and enter or modify applicable insurance information following VA policies, CPAC guidebooks, operating procedures, and Task Order instructions.

The role requires the ability to interpret complex insurance situations involving multiple coverage sources, policy effective and termination dates, subscriber relationships, sequencing and resequencing requirements, and coordination-of-benefits considerations. The specialist must also investigate rejected insurance entries and determine the appropriate corrective action or escalation path.

The draft PWS establishes particularly demanding production standards. Contractor performance is expected to achieve at least 93% on-time completion, individual data-entry quality not below 95%, and 100% review and action on rejected entries within five business days. The PWS also establishes confidentiality, system-access, meeting-attendance, and communication performance measures.

This position therefore requires someone who can maintain both production speed and accuracy, rather than achieving productivity by sacrificing data quality.

Key Functions of the Position

This position combines several related functions within a single full-time role:

Primary Function: Senior Insurance Entry and Verification Production
Perform high-volume insurance entry, validation, research, policy maintenance, and eligibility verification.

Secondary Function: Complex Insurance Policy Specialist
Handle difficult insurance situations requiring deeper payer research, policy interpretation, sequencing, coordination-of-benefits analysis, or discrepancy resolution.

Secondary Function: Rejection Resolution Specialist
Investigate erroneous or rejected insurance transactions, identify root causes, correct contractor-controllable issues, and escalate items requiring CPAC intervention.

Secondary Function: Peer Coach
Provide workflow guidance and technical assistance to insurance verification specialists on complex transactions, VA procedures, payer research techniques, and recurring processing issues.

Backup Function: Quality Reviewer
Conduct secondary quality reviews when assigned, provided the specialist does not independently approve his or her own production work.

Day-to-Day Activities

The Senior Medical Insurance Verification Specialist will be expected to:

• Verify patient medical and prescription insurance coverage using authorized VA applications, insurance carrier websites, payer portals, and other Government-approved information sources.
• Research payer records to confirm policy status, coverage effective dates, termination dates, subscriber information, policy identifiers, group information, and other required insurance data.
• Enter verified third-party insurance information accurately into authorized VA healthcare systems and related interfaces.
• Establish new insurance policies when valid third-party coverage is identified.
• Update existing insurance policies when coverage information, policy attributes, subscriber information, or effective dates change.
• Terminate insurance policies when research confirms that coverage is no longer active or applicable.
• Sequence and resequence insurance policies according to applicable VA procedures and coordination-of-benefits requirements.
• Evaluate multiple insurance policies to determine proper coordination-of-benefits treatment and identify inconsistencies requiring additional research.
• Interpret complex medical and prescription insurance documentation, payer information, and applicable processing guidance.
• Resolve insurance discrepancies by researching available data, comparing information across authorized sources, and taking appropriate corrective action.
• Investigate rejected or erroneous insurance entries to determine whether the issue resulted from incorrect data, system limitations, payer information, or another processing condition.
• Correct contractor-controllable rejected entries within established performance timeframes.
• Escalate policies that cannot be appropriately loaded, linked, corrected, or resolved to the designated CPAC representative in accordance with established procedures.
• Maintain required VA system and insurance-provider portal access and proactively address credential or access issues that could affect production.
• Protect Personally Identifiable Information and Protected Health Information throughout all processing activities.
• Follow CPAC guidebooks, VA policies, standard operating procedures, quality requirements, Task Order instructions, and documented processing updates.
• Apply updates to insurance-processing policies and procedures as new guidance is released.
• Perform self-quality checks before completing insurance transactions.
• Review the work of other specialists when formally assigned backup quality-review responsibilities.
• Identify recurring transaction errors, rejection patterns, payer issues, or workflow problems and communicate them to supervisory or quality personnel.
• Coach less-experienced team members on insurance verification research, complex policy processing, rejection resolution, and applicable work instructions.
• Document work accurately enough to support production, quality, workload, and performance reporting.
• Track assigned workload and complete transactions within Government-established processing periods.
• Communicate questions, discrepancies, access problems, and unresolved issues promptly to the appropriate supervisor or VA contact.
• Participate in required team meetings, Government conference calls, refresher training, policy updates, and quality-improvement activities.
• Support corrective-action activities when internal or Government quality reviews identify deficiencies.
• Maintain professional conduct, confidentiality, reliability, and productivity while working independently in a remote environment.