Medical EV

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