Insurance Verification-Eligibility Specialist

We are seeking a detail-oriented and analytical Insurance Verification & Eligibility Specialist to join our Revenue Cycle team. The ideal candidate will be responsible for verifying patient insurance coverage, determining eligibility, obtaining prior authorizations, and ensuring accurate documentation to support timely claim submission and payment. This role is critical in reducing claim denials, accelerating reimbursements, and supporting overall financial performance in a U.S. healthcare environment.

Key Responsibilities: Insurance Verification & Eligibility:

• Verify patient insurance coverage (commercial, Medicare, Medicaid, and other payers) prior to appointments or services.
• Confirm benefits, deductibles, co-insurance, co-payments, policy limitations, and exclusions.
• Review and interpret payer portals, EHR systems, and clearinghouses for real-time eligibility updates.
• Ensure accurate documentation of verified benefits in the system.

Authorization & Pre-Certification:

• Obtain prior authorizations as required by payers for specific procedures, diagnostic tests, or treatments.
• Communicate with insurance companies to resolve authorization discrepancies or incomplete information.
• Track authorization status and follow up to secure approvals before service dates.

Communication & Coordination:

• Coordinate with providers, schedulers, and billing teams to ensure all insurance-related requirements are met prior to patient appointments.
• Communicate coverage issues, payer requirements, or eligibility concerns to relevant teams promptly.
• Provide guidance to patients regarding coverage expectations, if required.

Documentation & Data Accuracy:

• Maintain complete and accurate patient insurance information in the practice management or billing system.
• Document all interactions, verification results, and authorization details in compliance with organizational policies.
• Identify and correct missing or outdated insurance information.

Denial Prevention & RCM Support:

• Identify potential coverage issues that may result in claim denials.
• Work closely with AR and Billing teams to support clean claim submission.
• Review denial trends related to coverage or eligibility and provide feedback to the team.

Qualifications & Requirements:Education:

• Bachelor’s degree preferred, but not mandatory.
• High school diploma or equivalent required.

Experience:

• 1–2 years of experience in U.S. Healthcare Revenue Cycle Management (Insurance Verification, Eligibility, Front-End RCM).
• Experience with commercial insurances, Medicare, Medicaid, and managed care plans preferred.
• Familiarity with EMR systems, clearinghouses, and payer portals.

Job Type: Full-time

Work Location: In person