Senior Eligibility Verification Agent

Department:

Reports To:

Summary:

• The Senior Back-End Registration Verification and Eligibility Specialist is responsible for ensuring the accuracy and completeness of patient registration data and verifying insurance eligibility after the patient encounter.
• This role focuses on resolving registration errors, investigating eligibility discrepancies, and working with payers to obtain accurate coverage information.
• The Senior Specialist handles complex cases, provides guidance to junior team members, and plays a key role in minimizing billing errors and maximizing reimbursement.

Key Responsibilities:

Registration Verification:

• Review patient registration data for accuracy and completeness, including demographics, insurance information, and guarantor details.
• Identify and correct errors in registration data, working with internal departments to obtain accurate information.
• Research and resolve registration-related claim denials.
• Maintain accurate and up-to-date patient records in the registration system.
• Work with front-end registration staff to improve data capture processes.

Insurance Eligibility Verification:

• Verify insurance eligibility using online portals, phone calls, and other methods after the patient has received services.
• Investigate and resolve eligibility discrepancies, such as incorrect insurance information or coverage gaps.
• Obtain accurate insurance coverage information from payers, including copays, deductibles, and coinsurance.
• Document all eligibility verification activities accurately and thoroughly in the billing system.
• Identify and resolve eligibility-related claim denials.

Payer Compliance:

• Stay current on payer-specific eligibility verification requirements.
• Ensure compliance with all applicable regulations and guidelines.
• Research and resolve payer-specific eligibility issues.

Data Analysis and Reporting:

• Prepare reports on registration and eligibility verification metrics, such as error rates and denial rates.
• Analyze data to identify trends and patterns in registration and eligibility issues.
• Recommend process improvements based on data analysis.

Team Leadership and Mentorship:

• Serve as a mentor and resource for junior Registration Verification and Eligibility Specialists.
• Provide guidance and support to the team on complex cases and eligibility challenges.
• Assist in training new team members on registration verification and eligibility procedures.

System Proficiency:

• Utilize registration systems, eligibility verification tools, and payer portals to perform job duties.
• Maintain accurate and up-to-date information in all systems.

Liaison Activities:

• Communicate with clinical and revenue cycle teams to resolve issues and facilitate accurate claim submission.

Qualifications, Experience & Skills:

• Undergraduate degree or equivalent required; Bachelor's degree in a related field preferred
• Minimum of 3-5 years of experience in patient registration, insurance eligibility verification, or related healthcare field.
• Strong knowledge of medical billing and insurance concepts.
• In-depth knowledge of insurance eligibility verification processes.
• Excellent communication and interpersonal skills.
• Strong analytical and problem-solving abilities.
• Proficiency in using registration systems, eligibility verification tools, and payer portals.
• Ability to work independently and as part of a team.
• Excellent organizational and time-management skills

Preferred Qualifications:

• Experience with EPIC preferred but not mandatory

• Both Hospital and Professional billing experience preferred
• Flexible to work from Office all 5 days in the week
• Voice - Eligibility Verification experience is relevant.