Eligibility, Benefits and Prior Authorization Specialist

Work shift: Night shift from 6 pm to 3 am

Work Location: Shahrah e Faisal, Karachi

Education: Bachelors

Experience: 1+ years in Eligibility, Benefits, and Prior Authorization under any Medical Billing company.

Benefits:

Dinner, OPD 8%, EOBI, PF 8% and Saturday/Sunday off.

Job Description:

Verification of Insurance Information (Provided by Practice Front Office / Client):

Provide Verified insurance information.

Use the patient's insurance card to gather necessary details like insurance company name, policy number, group number, and subscriber information with procedure Details

Insurance Eligibility Check:

· Utilize an eligibility verification system or software provided by insurance companies or third-party vendors.

· Input the patient's insurance information into the system.

User Should Collect:

Verify the patient's coverage details, including:

· Coverage status (active/inactive)

· Effective date of coverage

· Coverage type (e.g., HMO, PPO)

· Co-payments, deductibles, and coinsurance amounts

User Should add Data in Spreadsheet:

Ø Patient Name (Last, First)

Ø DOB

Ø Provider Name

Ø Network Status

Ø Auth Req Y/N

Ø If required, Escalate and ref Case #. In notes.

Ø Referral Req Y/N

Ø Ded Amount

Ø Ded Remaining

Ø Co-insurance

Ø Out of Pocket Remaining

Ø Pri. Ins

Ø Eff Date

User should Collect from Practice Management:

Ø Self-Pay (NP) - Y/N

Ø Self-Pay (Est) - Y/N

Ø Previous Patient Balance

Ø Insurance Balance

Ø Balance to Collect

Ø Notes

Coverage limits or restrictions

· Ensure the system provides real-time information whenever possible.

Verification Review and Resolution:

· Review the eligibility results thoroughly for accuracy and completeness.

· Resolve any discrepancies or issues identified during the verification process from Availity & PM

· Contact the patient or insurance company for clarification if needed.

Documentation:

· Document the results of the eligibility verification process in the patient's EHR.

· Include details such as the date of verification, verification status, and any notes regarding discrepancies or follow-up actions.

Job Type: Full-time

Application Question(s):

• Do you have a bachelor's Degree?
• Can you speak English fluently?
• How much experience do you have in Eligibility, Prior Authorization and Benefits?
• Please mention you current and expected salary in USD?

Work Location: In person