The Eligibility & Verification Specialist is responsible for verifying patients' insurance coverage and eligibility for services. This role ensures that all necessary pre-authorization and insurance requirements are met prior to service delivery, reducing denials and optimizing reimbursement. The ideal candidate has strong attention to detail, excellent communication skills, and a solid understanding of insurance processes and regulations.
Key Responsibilities:
Verify patient insurance eligibility and benefits through payer portals, phone calls, or electronic verification systems.
Determine co-pays, deductibles, co-insurance, and out-of-pocket responsibilities.
Ensure required authorizations or referrals are obtained before services are rendered.
Accurately update insurance information and verification notes in the patient management system.
Work closely with front desk, billing, and clinical staff to resolve coverage issues.
Contact patients regarding their insurance coverage and explain financial responsibility if needed.
Track and follow up on pending verifications and authorizations.
Maintain compliance with HIPAA and all payer and regulatory requirements.
Identify and escalate complex coverage or authorization issues to supervisors or appropriate departments.
Qualifications:
Required:
High school diploma or GED.
2+ years of experience in medical insurance verification, eligibility, or a similar role.
Knowledge of commercial, Medicare, Medicaid, and managed care plans.
Please share your cv to ssangar@scale-healthcare.in or can call us at 8699557349
Job Type: Full-time
Pay: ₹23,000.00 - ₹45,000.00 per month
Work Location: In person
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