Eligibility & Insurance Verification-Medical Billing

We are seeking a highly detail-oriented and organized Insurance Verification & Authorization Specialist to join our medical billing team. This role is critical in ensuring accurate insurance eligibility verification, timely procurement of prior authorizations, and complete documentation to support efficient billing and claims processing. The ideal candidate demonstrates strong communication skills, meticulous attention to detail, and a thorough understanding of payer requirements, while thriving in a fast-paced healthcare environment.

Key ResponsibilitiesInsurance Verification & Eligibility

• Verify patient insurance coverage using payer portals and direct communication with insurance carriers.
• Maintain accurate and current eligibility information within the Electronic Health Record (EHR) system, such as eClinicalWorks.
• Complete, upload, and document insurance verification materials promptly for all new patient registrations.
• Clearly explain estimated patient financial responsibility, including copays, deductibles, and out-of-pocket costs.
• Escalate unresolved eligibility discrepancies or coverage issues to the Patient Collections team when necessary.
• Proactively contact patients to obtain missing, corrected, or updated insurance information.

Authorizations & Regulatory Compliance

• Obtain prior authorizations for medical and behavioral health services requiring payer approval.
• Ensure adherence to Medicaid and other payer-specific authorization guidelines and policies.
• Collaborate with the Patient Services team to manage out-of-network insurance situations.
• Secure authorizations for psychological assessments while maintaining accurate documentation and system alerts.

Operational Support & Collaboration

• Provide support for urgent or same-day appointment scheduling as needed.
• Track and communicate updates related to payer policies, billing issues, and provider network participation.
• Work closely with the Practice Manager to resolve incomplete or inaccurate patient intake documentation.
• Participate in team meetings focused on workflow optimization, data accuracy, and continuous process improvement.

Job Type: Full-time

Pay: Rs45,000.00 - Rs70,000.00 per month

Work Location: In person