JOB TITLE: No Fault / PIP Insurance Verification Specialist II
EMPLOYER: Progressive Spine & Orthopaedics
PAY RANGE: OPM Pay Grade 5 (Hourly)
FSLA STATUS: Non-Exempt
SUMMARY: The No-Fault / PIP Insurance Verification Specialist verifies and documents automobile insurance benefits and claim information prior to patient services. The position works with insurance carriers, adjusters, attorneys, and internal teams to confirm coverage, identify authorization requirements, obtain supporting documentation, and maintain accurate information in the electronic health record. The role supports timely patient care, billing accuracy, and compliance by ensuring No-Fault / PIP information is complete and current.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Verify active No-Fault / PIP claims, including claim number, date of accident, adjuster information, benefit status or exhaustion, covered body parts, and other applicable coverage details.
- Confirm policy and accident state information, liability or policy limits when available, and payer billing or contact information needed to support patient care and billing.
- Determine whether precertification or prior authorization is required for applicable services, including office visits, radiology, and other ordered treatment, and document the appropriate payer contact information.
- Communicate with insurance carriers, adjusters, attorneys, and legal staff to clarify benefits, resolve missing or conflicting information, and obtain required documentation.
- Request and review supporting No-Fault documentation as applicable, including PIP ledgers, police reports, declaration pages, and relevant medical records.
- Coordinate Letters of Protection (LOPs) when appropriate, including obtaining attorney confirmation, sending required requests, and ensuring completed documentation is added to the patient record.
- Maintain complete verification documentation in the EHR, including insurance notes, verification forms, task notes, appointment-related information, and patient chart alerts or sticky notes as applicable.
- Identify coverage discrepancies, exhausted benefits, missing documentation, or other barriers; escalate issues appropriately and follow HIPAA and established verification workflows.
QUALIFICATIONS
- Previous experience with No-Fault / PIP insurance verification, automobile claims, medical benefits, or a related healthcare administrative function preferred.
- Working knowledge of insurance eligibility, claim verification, authorization requirements, and healthcare documentation practices.
- Strong attention to detail and the ability to review insurance, medical, and legal documentation for accuracy and completeness.
- Professional verbal and written communication skills with the ability to manage follow-up with adjusters, attorneys, patients, and internal staff.
- Ability to organize multiple verification requests and outstanding items; proficiency with EHR systems and standard office software. ModMed and Microsoft Excel experience is a plus.
CORE COMPETENCIES
Accuracy and attention to detail, organization and follow-through, insurance and claim research, professional communication, problem-solving, confidentiality, team collaboration
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The position is primarily performed in a professional medical office environment. Work requires prolonged periods of sitting and computer use, with occasional standing, walking, bending, reaching, and movement throughout the office. Frequent use of a computer keyboard, mouse, telephone, scanner, and other standard office equipment is required. The position requires the ability to review and process detailed insurance, claims, medical, and legal documentation, maintain confidentiality, and communicate effectively by telephone, email, and electronic systems.
DOL / FLSA CLASSIFICATION AND JUSTIFICATION
This position is classified as Non-Exempt because its primary responsibilities involve insurance verification, claims research, authorization review, documentation, and administrative follow-up performed according to established procedures and payer requirements. While the role requires specialized knowledge and problem-solving, it does not independently exercise discretion and judgment on matters of significance at the level required for the FLSA administrative exemption. The position is therefore eligible for overtime in accordance with applicable federal and state laws.
The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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