Eligibility Specialist

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Job Title: Verification of Benefits and Authorization Specialist

About the Company:

Our client is a leading provider of healthcare administrative services, dedicated to streamlining the patient journey and supporting healthcare professionals.

Job Description:

We are seeking a detail-oriented Verification of Benefits and Authorization Specialist to join our team. This role is crucial in ensuring that patients receive the necessary approvals for their medical services and that all insurance benefits are accurately verified. You will be the first point of contact for patients and insurance providers, playing a key role in the revenue cycle management of our client.

The ideal candidate will have a strong understanding of medical insurance, prior authorization processes, and excellent communication skills. You will work closely with clinical staff, patients, and insurance companies to facilitate seamless healthcare access.

Responsibilities of the role:

• Verify patient insurance eligibility and benefits coverage.

• Obtain pre-authorizations and pre-certifications for medical procedures and services.

• Communicate with insurance companies to resolve authorization issues and claim denials.

• Document all verification and authorization activities accurately in the patient's record.

• Educate patients on their benefits, coverage, and any out-of-pocket expenses.

• Collaborate with physicians and clinical staff to ensure all necessary documentation is submitted.

Required Experience and Qualifications:

• High school diploma or equivalent.

• Proven experience in medical insurance verification and/or prior authorization.

• Familiarity with various insurance plans (HMO, PPO, Medicare, Medicaid).

• Strong understanding of medical terminology and coding (ICD-10, CPT).

• Excellent communication and interpersonal skills.

• Proficient in using EMR/EHR systems and other relevant software.

Preferred Skills:

• Associate's degree in healthcare administration or a related field.

• Certification from a relevant professional organization (e.g., CPMSM, CHAA).

Personality:

• Highly organized and detail-oriented.

• Proactive and able to work independently.

• Empathetic and patient-focused.

• Strong problem-solving abilities.

Software & Tools:

• Electronic Health Record (EHR) systems

• Practice Management Software

• Microsoft Office Suite (Word, Excel, Outlook)

Schedule:

Monday to Friday

9:00 AM - 5:00 PM EST

Salary and Benefits:

• Payment in USD or Local Currency according to candidate's preference.

• Full-time remote opportunity.