About Carepatron
At Carepatron, we're building the practice management platform that lets health and wellness practitioners spend more time with clients and less time on admin. Tens of thousands of practitioners across mental health, allied health, physical therapy, and specialty care already run their practices on Carepatron, and we're on a mission to make great healthcare experiences universal — for practitioners and the people they serve.
We're a distributed team across New Zealand, Australia, the US, the UK, and beyond. Small enough that your work is visible and your judgement is trusted; serious enough that the systems you help build support hundreds of thousands of real care experiences every week.
About the Role
As a Senior Insurance Verification Specialist, you'll lead how we confirm coverage, benefits, and authorization requirements for the patients our customers serve. You'll work across commercial, Medicare, and Medicaid payers to verify eligibility before services are rendered — catching the issues that cause denials before they happen, and setting every claim up for a clean path through reimbursement.
Beyond execution, you'll shape how verification is done at Carepatron: building playbooks, coaching newer team members, and partnering with product and RCM leadership on how we scale this work as the team grows.
What You'll Do
- Run comprehensive insurance verifications across commercial, Medicare, Medicaid, and workers comp plans — confirming active coverage, in-network status, copays, deductibles, coinsurance, out-of-pocket maximums, and benefit limitations.
- Own prior authorizations end-to-end: identify services that need authorization, initiate requests, follow up with payers, and close the loop so care isn't delayed.
- Work directly within payer portals (Availity, Navinet, Change Healthcare, and payer-specific systems) and by phone when the portal isn't enough.
- Document verifications cleanly so billing, scheduling, and clinical teams all operate from a single source of truth.
- Untangle the hard cases — coordination of benefits, secondary and tertiary payers, Medicare Advantage nuances, carve-outs, and out-of-state coverage.
- Coach and mentor the team: share payer quirks, teach patterns, review other specialists tricky cases, and help raise the bar.
- Partner across functions — Credentialing & Enrollment, Billing, RCM, and Customer Success — so denials get prevented at the source, not patched after the fact.
- Drive improvements: spot patterns in verification failures, and propose process changes, training, or automations that fix them at the root.
What You'll Bring
- 4+ years of insurance verification experience in a US healthcare setting (outpatient, behavioral health, specialty, or multi-specialty).
- Fluency with CPT and ICD-10 codes, modifiers, and how they drive benefits and authorization outcomes.
- Deep working knowledge of commercial payers, Medicare, Medicaid, and state-specific programs.
- Hands-on experience with payer portals, clearinghouses, and at least one practice management or EHR system.
- Strong grasp of prior authorization workflows across payer types — including inpatient, outpatient, DME, and specialty procedures.
- Exceptional attention to detail: you triple-check coverage because you know a single missed field becomes a denial weeks later.
- Clear, empathetic written communication — you can explain complex coverage scenarios to clinicians and patients in plain language.
- Reliability and ownership: you close loops without being asked.
Nice to Have
- Experience leading or mentoring a verification team.
- Familiarity with behavioral health, PT/OT/SLP, or specialty care verification nuances.
- Exposure to RCM analytics and denial root-cause analysis.
- Experience working remotely across time zones with distributed teams.
Why Join Us
If you care about healthcare done well, want to work with people who take craft and customers seriously, and prefer getting things done over performing busy-ness, you'll fit here. We back people to own their area, review each other's work honestly, and keep a calm rhythm — no performance-review theatre, no surprise weekend fire drills.
What we offer
- Fully remote work with flexible hours that respect your time zone
- A mission-led team that ships, reviews, and backs you to own your area
- Clear paths to grow as Carepatron's RCM function scales
- Meaningful equity in a profitable, fast-growing healthcare company
- A calm, focused culture — outcomes over optics
How to Apply
Send us your CV and a short note telling us about a time you caught a verification issue that would have led to a denial — or a payer quirk you now know cold.
We read every application. No cover letter template required — just make it real.
