Eligibility and Benefits Verification Specialist - US Healthcare

Summary:

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.