TL - Eligibility

Role & responsibilities

• Verify patient eligibility and benefits:

  This involves contacting insurance companies, accessing online portals, and reviewing patient information to confirm coverage and benefits for specific services.

• Gather and document patient insurance information:

  Collect details like policy numbers, insurance company names, and plan types, ensuring accurate and complete records.

• Determine patient responsibility:

  Identify co-pays, co-insurance, deductibles, and other financial obligations the patient may have.

• Communicate with insurance companies and patients:

  Address questions, resolve issues, and ensure smooth communication regarding insurance coverage and benefits.

• Maintain accurate records and documentation:

  Keep a detailed record of verification efforts, including notes, dates, and outcomes.

• Identify and resolve discrepancies:

  Detect and address any issues or errors in patient insurance information or coverage.

• Stay updated on insurance policies and procedures:

  Remain informed about changes in insurance plans, regulations, and verification processes.

• Contribute to revenue cycle improvements:

  By ensuring accurate eligibility and benefits verification, contribute to efficient billing and timely reimbursement.

Required Skills & Qualifications

• Bachelors degree in any discipline (Healthcare background preferred).
• Minimum 35 years of experience in Eligibility & Benefits verification, with 12 years in a team lead/supervisory role.
• Strong knowledge of US healthcare insurance, benefits, payer rules, and EMR/PM systems.
• Good communication, analytical and problem-solving skills.
• Ability to work with tight deadlines and manage team performance effectively.

Preferred candidate profile

Team Leads and Assistant Managers working in US Health care

Any Graduate or Post Graduate with good communication skills , leadership skills, Team Handling skills.

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