Eligibility and Benefits Verification Specialist

3 weeks ago

Borivali, India HANR Support Services Pvt. Ltd. Full time

Summary:
The Eligibility and Benefits Verification Specialist is responsible for confirming patient insurance coverage and benefits prior to medical appointments or procedures. This role ensures accurate verification and pre-authorization processes to prevent billing issues and facilitate a smooth revenue cycle, while assisting patients in understanding their financial responsibilities.

Key Responsibilities:

  • Collect and verify patient demographic and insurance information accurately.
  • Confirm insurance eligibility using online payer portals, phone calls, or automated services.
  • Determine detailed benefit information including co-pays, deductibles, coinsurance, and out of-pocket maximums.
  • Obtain and track necessary pre-authorizations or pre-certifications for medical services.
  • Document all verification and authorization communications in the Electronic Health Record (EHR) system.
  • Collaborate with billing, clinical staff, and other departments to resolve insurance discrepancies.
  • Stay updated on insurance policy changes, including managed care and government programs like Medicare.
  • Ensure compliance with HIPAA and maintain strict patient confidentiality.
  • Assist in identifying process improvement opportunities within eligibility verification workflows.

Required Skills:

  • Proficiency with EHR software (e.g., Tebra/Kareo, WeInfuse), insurance payer portals.
  • Excellent verbal and written communication skills, with the ability to interact professionally with patients, providers, and insurers. Bilingual skills are a plus.
  • Exceptional attention to detail and organizational skills for accurate data handling.
  • Strong problem-solving skills to address insurance coverage and billing issues effectively.
  • Ability to work independently and collaboratively in a fast-paced environment.
  • Good working knowledge of Microsoft applications such as Outlook, Teams, Excel, Word, and MS PowerPoint.

Desired Attributes:

  • High level of professionalism, diplomacy, and composure in sensitive situations.
  • Ability to adapt to policy changes and regulatory requirements.
  • Customer-focused mindset with strong teamwork abilities.
  • Familiarity with healthcare compliance regulations and documentation best practices.

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