Eligibility & Benefits Verification Specialist
- Verification Execution: Timely verify patient insurance eligibility, coverage status, and benefit details using payer websites/portals, electronic verification tools, and direct calls to insurance carriers.
- Benefit Detail Capture: Obtain and document specific benefit information, including co-pays, deductibles, coinsurance amounts, out-of-pocket maximums, and in network/out-of-network benefits for the services scheduled.
- Documentation: Accurately and comprehensively document all verification results, reference numbers, contact details, and confirmation details in the client's practice management system or EMR.
- Service Specifics: Confirm benefit limitations, referral requirements, pre-authorization needs, and covered services specific to the scheduled patient encounter (e.g., lab work, specialty visits).
- Communication: Communicate any coverage issues or discrepancies back to the client/provider teams promptly to ensure accurate patient financial counseling.
- Workflow Management: Prioritize verification tasks based on appointment schedules and urgency, ensuring adherence to client turnaround time (TAT) requirements.
- Compliance: Ensure all verification activities adhere to HIPAA guidelines and client specific protocols.
- Quality & Productivity: Meet and maintain high daily productivity and quality targets related to verification accuracy.
- Experience: 6 months to 2 years of experience in U.S. Healthcare Eligibility & Benefits Verification or Front-Office Operations is highly preferred. (Freshers with excellent communication and attention to detail may be considered).
- Education: Any graduate or diploma holder.
- RCM Knowledge: Basic understanding of insurance terminology, different payer types (Commercial, Medicare, Medicaid), and how verification impacts the revenue cycle.
- Technical Proficiency: Experience navigating insurance payer portals and verification tools. Strong computer skills and familiarity with EMR/PM systems is a plus.
- Communication: Excellent verbal and written communication skills for professional interaction with payers and clear documentation.
- Organizational Skills: Exceptional organizational and prioritization abilities to manage a high volume of time-sensitive requests.
- Accuracy: Proven ability to handle information with meticulous attention to detail.
- High Accuracy and Compliance
- Organizational and Prioritization Skills
- Time Management and Urgency
- Attention to Detail
- Effective Communication
- Shift Timings: Day & Night Shift
- Work Schedule: Sunday & Monday off for day shift, Saturday & Sunday off for night shift (schedule may vary slightly based on client requirements).