Medical Coder / Medical Biller

MEDICAL CODER / MEDICAL BILLER

We are looking for a detail-oriented and proactive Eligibility Executive to manage insurance verification and benefits validation for patients in the revenue cycle process. The ideal candidate will have experience working with U.S. healthcare insurance systems, payer portals, and EHR platforms to ensure accurate eligibility checks and timely updates for claims processing.

Key Responsibilities

1. Verify patient insurance coverage and benefits through payer portals, IVR, or direct calls to insurance companies.
2. Update and confirm insurance details in the practice management system or EHR platforms accurately and in a timely manner.
3. Identify policy limitations, deductibles, co-pays, and co-insurance information and document clearly for billing teams.
4. Coordinate with patients and internal teams (billing, front desk, scheduling) to clarify eligibility-related concerns.
5. Perform eligibility checks for scheduled appointments, procedures, and recurring services.
6. Handle real-time and batch eligibility verifications for various insurance types including commercial, Medicaid, Medicare, and TPA.
7. Escalate discrepancies or inactive coverage to the concerned team and assist in resolving issues before claim submission.
8. Maintain up-to-date knowledge of payer guidelines and insurance plan policies.
9. Ensure strict adherence to HIPAA guidelines and maintain confidentiality of patient data.
10. Meet assigned productivity and accuracy targets while following internal SOPs and compliance standards.

1Preferred Skills & Tools

• Experience with EHR/PM systems like eCW, NextGen, Athena, CMD
• Familiarity with major U.S. insurance carriers and payer portals
• Strong verbal and written communication skills
• Basic knowledge of medical billing and coding is a plus
• Ability to work in a fast-paced, detail-focused environment

Qualifications

ANY LIFE SCIENCE DEGREE

BSc, MSc, B.Pharm, M.Pharm, BPT

NOTE

CPC certification preferable

Shift & Work Details:

• Shift Timing: Night Shift 9:00 PM to 7:00 AM
• Work Days: [Monday to Friday]
• Gender: Male candidates only (due to night shift operational requirements)