Process Associate/Sr. Process Associate (Insurance Eligibility and Benefit Verification)

Position:

Location:

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Experience:

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Role overview:

The Insurance Eligibility and Benefit Verification Specialist is responsible for verifying patient insurance eligibility and benefits prior to medical services being provided. This role ensures that accurate insurance information is obtained and communicated to the medical providers, ensuring smooth billing processes and reducing the likelihood of claim denials or delays. This position plays a critical role in the revenue cycle management for healthcare providers.

Responsibilities & duties:

Verify patient insurance eligibility and benefits through online portals or direct

communication with insurance carriers.

Accurately document insurance coverage details, including co-pays, deductibles, and out-of-pocket maximums.

Collaborate with healthcare providers to obtain prior authorizations for medical procedures andtreatments.

Resolve discrepancies in insurance information and address coverage issues promptly.

Communicate effectively with patients regarding their insurance coverage and financial responsibilities.

Preferred Skills:

Strong understanding of insurance terminology, medical coding (CPT, ICD-10, HCPCS), and insurance plans.

Proficiency with medical billing software, Electronic Health Records (EHR) systems, and online insurance portals.

Excellent written and verbal communication skills, with the ability to interact professionally with patients, insurance companies, and healthcare providers.

Detail-oriented, organized, and able to manage multiple tasks in a fast-paced environment.

Knowledge of HIPAA and other healthcare privacy and compliance standards.

Experience with Medicare, Medicaid, PPO, HMO, and commercial insurance plans.

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