Eligibility & Verification

Job Title: Eligibility & Verification Specialist

Job Summary:

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