Eligibility Verification

4 days ago

Hyderabad, Telangana, India H M Healthcare Solution Full time ₹ 40,00,000 - ₹ 80,00,000 per year

Payment Posting Role & responsibilities:

  • Post insurance and patient payments (manual and electronic) accurately into the billing system.
  • Ensure payments are applied to the correct patient accounts, dates of service, and CPT codes.

  • Enter EOBs (Explanation of Benefits) and ERAs (Electronic Remittance Advices) promptly and correctly.

  • Identify denied or partially paid claims and route them to the denial management or A/R team for follow-up.

  • Review and verify insurance payment information from EOBs and ERAs.

  • Collaborate with accounts receivable, charge entry, and denial management teams to resolve payment-related issues.

  • Communicate with insurance companies to clarify unclear payments or missing remittance details.

Eligibility verification Role & responsibilities:

Patient Insurance Verification

  • Verify patients insurance eligibility via payer portals, clearinghouses, or direct calls.
  • Confirm policy status, effective dates, plan type, and coverage limits.
  • Validate demographic and insurance details entered in the system.

Benefits and Authorization

  • Verify specific benefits such as copay, coinsurance, deductible, and visit limits.
  • Check if prior authorization or referral is required for scheduled procedures.
  • Communicate benefit details and out-of-pocket estimates to patients and front office teams.
  • Work closely with AR teams to resolve eligibility-related denials.

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