Job Description

Medical Eligibility & Verification (EV) Specialist

Location:

Ahmedabad

Shift:

Night Shift (US Process)

Job Type:

On-site / Hybrid

Job Summary:

We are looking for a detail-oriented

Medical Eligibility & Verification Specialist

to handle insurance verification for US-based healthcare clients. The role involves verifying patient eligibility, insurance benefits, and prior authorizations to ensure accurate and timely claim processing.

Key Responsibilities:

Verify patients' insurance coverage, eligibility, and benefits before appointments or procedures. Confirm active policies and coverage details directly with insurance carriers (via calls or portals). Obtain prior authorizations or pre-certifications as required. Accurately document verification details in the billing system. Communicate with providers and patients regarding coverage limitations or missing information. Coordinate with billing and coding teams to resolve any coverage-related issues. Maintain confidentiality and adhere to HIPAA compliance standards.

Required Skills & Qualifications:

Minimum

1-3 years

of experience in Medical Eligibility & Verification / RCM process. Strong understanding of US healthcare insurance terminology and payer rules. Proficiency in working with payer portals and healthcare billing systems. Excellent verbal and written communication skills (English). Attention to detail and ability to multitask in a fast-paced environment. Knowledge of

Medicare, Medicaid, PPO, HMO

plans preferred.

Educational Qualification:

Graduate in any discipline (Preferred: Healthcare, Life Sciences, or related field).
Job Type: Full-time

Pay: ₹10,000.00 - ₹30,000.00 per month

Work Location: In person