eligibility specialist

Savista

<div>Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
Job Purpose 
The Eligibility Specialist I is a critical advocate for patients, helping uninsured and underinsured individuals access financial assistance for medical care. This role involves conducting detailed assessments, guiding patients through application processes for government and charity-funded programs and ensuring compliance with healthcare regulations. Successful candidates are empathetic, detail-oriented, and skilled at navigating healthcare systems to support patients in receiving the care they need.
Work Schedule and Location:
<ul><li>Work Hours: Full time, 40 hours per week, hourly position. Flexibility required, with shifts available between the days and hours of Monday through Saturday from 8:00am to 6:00pm to meet business needs.</li><li>
Primary Locations: This position is onsite and will be required to service the primary hospital locations of:<ul><li><h2 class="jobSectionHeader">
HonorHealth Scottsdale Osborn Medical Center: 7400 E Osborn Rd Scottsdale, AZ 85251</h2></li></ul></li></ul>
Key Responsibilities<ul><li>
Meet with patients in-person, including bedside visits, to assess financial assistance eligibility and provide compassionate guidance on available programs.</li><li>
Facilitate the application process for programs such as Medicaid, Medicare, Disability, and hospital charity care, ensuring timely submission of accurate documentation.</li><li>
Act as a liaison between patients, hospital staff, and government agencies to establish eligibility, secure funding and resolve coverage issues.</li><li>
Manage multiple patient cases, prioritizing tasks to meet deadlines and ensure effective follow-up on pending applications.</li><li>
Clearly communicate financial obligations, funding options, and program details to patients in an empathetic and professional manner.</li><li>
Maintain accurate and confidential records in compliance with HIPAA and organizational policies.</li><li>
Consistently achieve productivity and quality metrics, contributing to the organization's financial counseling objectives.</li><li>
Efficiently use multiple systems and databases to gather, track, and report on patient data.</li><li>
Assist with vacancy coverage, as needed.</li><li>
Complete special projects, as assigned.</li></ul>
Qualifications &amp; Competencies:
Required:<ul><li>
High school diploma or GED</li><li>
At least 1 year of experience in a customer-facing role, preferably in healthcare or financial counseling.</li><li>
Flexibility to provide support at nearby hospital locations within assigned market area, as needed for vacancy coverage.</li><li>
Strong organizational skills with the ability to handle multiple priorities and maintain accuracy and attention to detail.</li><li>
Excellent verbal and written communication skills, with the ability to explain complex information clearly and empathetically.</li><li>
Ability to identify solutions to financial challenges, leveraging program knowledge to benefit patients.</li><li>
Capability to work in a fast-paced environment with changing priorities and patient needs.</li><li>
Demonstrate genuine care for patients&rsquo; needs and concerns, building trust and rapport.</li><li>
Work effectively with colleagues, hospital staff, and external agencies to achieve shared goals.</li><li>
Ensure all documentation is accurate, complete, and submitted on time.</li></ul>
Preferred:<ul><li>
Experience in healthcare revenue cycle, financial counseling, or insurance verification.</li><li>
Basic knowledge of state and federal assistance programs such as Medicaid, Medicare, and Social Security Disability.</li><li>
Knowledge of medical terminology and healthcare accounts receivable processes.</li></ul>
Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $19 to $21 per hour. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
California Job Candidate Notice</div>

Eligibility Specialist 1

Arizona Department of Economic Security

<div><div>YOU MUST APPLY TO THIS LINK TO BE CONSIDERED: https://www.azstatejobs.gov/jobs/benefits-and-eligibility-specialist-eligibility-interviewer-bullhead-city-arizona-united-states-95b757bb-879a-49f6-a846-1ced8def9968 
 
Job Summary:</div><div>
This position assists individuals and families applying for Medical Assistance, Nutrition Assistance, and Cash Assistance programs. The role provides customer support in a call center or field office environment, guiding applicants through the interview and application process while ensuring accurate eligibility determinations. 
</div><div>
New employees receive paid classroom and on-the-job training to build the skills needed to perform the work successfully. 
</div><div>
Key Responsibilities:</div><ul><li>
Provide professional and empathetic customer service by phone or in person.</li><li>
Conduct interviews and gather information to determine program eligibility.</li><li>
Enter and review information in multiple computer systems while assisting applicants.</li><li>
Explain eligibility requirements and connect applicants to appropriate resources.</li><li>
Maintain service standards for accuracy, timeliness, and customer support in a high-volume environment.</li></ul><div></div><div> 
Skills That Support Success:</div><ul><li>
Clear verbal and written communication.</li><li>
Customer service and active listening skills.</li><li>
Ability to navigate multiple computer systems and screens.</li><li>
Critical thinking and decision-making skills.</li><li>
Attention to detail and basic math skills.</li>
Ability to work independently and collaboratively in a team setting. 
<li>
</li></ul><div>
Helpful Background:</div><ul><li>
Experience in customer service, call centers, case processing, or eligibility reviews may be helpful but is not required. A High School Diploma or GED may support success in this role.</li></ul><div></div><div> 
Pre-Employment Requirements:</div><ul><li>
Background and reference checks are required.</li><li>
Employment eligibility verification through E-Verify.</li><li>
Some positions may require a valid driver&rsquo;s license if driving is required for State business.</li></ul><div></div><div> 
YOU MUST APPLY TO THIS LINK TO BE CONSIDERED: https://www.azstatejobs.gov/jobs/benefits-and-eligibility-specialist-eligibility-interviewer-bullhead-city-arizona-united-states-95b757bb-879a-49f6-a846-1ced8def9968</div></div>

Benefits & Eligibility Specialist

Alopex

<div>
 
 Job Title: Patient Access &amp; Eligibility Specialist
 
 
 
 Overview:
 
 
 The Patient Access &amp; Eligibility Specialist plays a critical role in supporting patient access to care management services by ensuring accurate insurance verification, confirming program eligibility, and assisting patients through administrative intake processes.
 
 
 This role serves as the front door to the care management program, helping identify eligible patients for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and other virtual care services.
 
 
 The Patient Access &amp; Eligibility Specialist verifies insurance coverage, confirms patient eligibility, answers incoming patient calls, manages voicemail communications, and ensures accurate documentation within electronic medical record (EMR) systems and care management platforms.
 
 
 The ideal candidate has strong technical proficiency, excellent communication skills, and the ability to navigate multiple healthcare systems efficiently while delivering a professional and compassionate patient experience.
 
 
 Reports To: Nursing Manager
 
 
 Department: Clinical Operations
 
 
 
 Job Description
 
 :
 
 
 
 Patient Call Management &amp; Communication
 
 
 
 <ul>
 <li>
 Answer incoming patient calls and provide professional, courteous assistance.
 </li>
 <li>
 Respond to patient inquiries related to care management programs and services.
 </li>
 <li>
 Manage voicemail systems by reviewing incoming messages and ensuring calls are routed to the appropriate team member or department.
 </li>
 <li>
 Coordinate call routing to Care Coordinators, Enrollment Specialists, or other staff based on patient needs.
 </li>
 <li>
 Ensure patient messages are handled promptly and accurately to support timely follow-up.
 </li>
 <li>
 Document all patient communications within the care management platform.
 </li>
 <li>
 Maintain strict adherence to HIPAA and patient privacy standards during all interactions.
 
 
 </li>
 </ul>
 
 Insurance Verification &amp; Eligibility Determination
 
 
 
 <ul>
 <li>
 Verify patient insurance coverage and eligibility for care management programs.
 </li>
 <li>
 Confirm payer requirements for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and other services.
 </li>
 <li>
 Review patient benefits, coverage status, and eligibility criteria.
 </li>
 <li>
 Identify patients who qualify for enrollment in care management programs.
 </li>
 <li>
 Document eligibility verification results in the appropriate systems.
 
 
 </li>
 </ul>
 
 Enrollment Pipeline Support
 
 
 
 <ul>
 <li>
 Prepare eligible patient lists for the Enrollment team by verifying eligibility and insurance coverage.
 </li>
 <li>
 Flag patients who meet program criteria for outreach and enrollment.
 </li>
 <li>
 Support enrollment readiness by ensuring patient demographic and insurance data is accurate.
 </li>
 <li>
 Communicate eligibility findings with Enrollment Specialists to support effective patient outreach.
 </li>
 <li>
 Assist with administrative preparation for patient enrollment processes.
 
 
 </li>
 </ul>
 
 Administrative &amp; Platform Support
 
 
 
 <ul>
 <li>
 Maintain accurate patient demographic and insurance information within care management platform.
 </li>
 <li>
 Assist with patient record updates and administrative workflows related to care management services.
 </li>
 <li>
 Ensure documentation is accurate, complete and compliant with program requirements.
 </li>
 <li>
 Support internal teams with patient information verification and administrative tasks.
 
 
 </li>
 </ul>
 
 Technology &amp; Data Accuracy
 
 
 
 <ul>
 <li>
 Utilize electronic medical records (EMR), care management platforms, and telephony systems to support patient access workflows.
 </li>
 <li>
 Demonstrate strong technical proficiency when navigating multiple healthcare platforms simultaneously.
 </li>
 <li>
 Maintain a high level of accuracy when entering patient information into healthcare systems.
 </li>
 <li>
 Assist with resolving minor data discrepancies and escalate system issues when necessary.
 
 
 </li>
 </ul>
 
 Qualifications and Skills Required:
 
 
 
 <ul>
 <li>
 1&ndash;3 years of experience in healthcare administration, patient access, insurance verification, or care coordination support
 </li>
 <li>
 Experience verifying health insurance eligibility and benefits
 </li>
 <li>
 Familiarity with Chronic Care Management (CCM), Remote Patient Monitoring (RPM), or population health programs preferred
 </li>
 <li>
 Experience working with electronic medical record (EMR) systems
 </li>
 <li>
 Strong technical proficiency and ability to learn new healthcare platforms quickly
 </li>
 <li>
 Experience handling patient phone calls in a professional healthcare environment
 </li>
 <li>
 Excellent verbal communication and patient engagement skills
 </li>
 <li>
 Strong organizational and time management abilities
 </li>
 <li>
 High attention to detail and documentation accuracy
 
 
 </li>
 </ul>
 
 Competencies:
 
 
 
 Competency
 
 
 Definition
 
 
 Patient Communication
 
 
 Provides clear, compassionate communication when assisting patients.
 
 
 Insurance Verification
 
 
 Demonstrates strong understanding of insurance coverage and eligibility processes.
 
 
 Technical Acumen
 
 
 Navigates EMR systems and healthcare technology platforms efficiently.
 
 
 Attention to Detail.
 
 
 Ensures accuracy in documentation and patient data entry.
 
 
 Compliance Awareness
 
 
 Maintains HIPAA compliance and proper handling of protected health information.
 
 
 Organization
 
 
 Manages multiple tasks and systems effectively in a fast-paced environment.
 
 
 Collaboration
 
 
 Works closely with Enrollment Specialists, Care Coordinators, and operations staff.
 
 
 Key Performance Indicators (KPIs)
 
 
 <ul>
 <li>
 Insurance verification accuracy rate
 </li>
 <li>
 Eligibility verification turnaround time
 </li>
 <li>
 Patient call response quality and timeliness
 </li>
 <li>
 Voicemail response and routing accuracy.
 
 
 </li>
 </ul>
 
 Work Location, Shift &amp; Schedule
 
 
 
 This position is remote (please see remote requirements below). Shifox/Alopex employees work Monday-Friday r according to the business hours of client practices.
 
 
 
 Remote Position Requirements:
 
 
 
 Reliable and stable Internet &ndash; all programs used by
 
 Patient Access &amp; Eligibility Specialist
 
 are internet based. A quiet and professional work environment suitable for speaking with patients about sensitive information and Protected Health Information (PHI), free of distractions.
 
 
 
 Compensation
 
 :
 
 
 Contractors are paid on a monthly basis, see below.
 
 
 Rate $17.00-$18.00 per hour
 
 
 Powered by JazzHR
 
 
 NQ9bHKexNO
</div>

Patient Access & Eligibility Specialist

<div>
 
 Job Title: Patient Access &amp; Eligibility Specialist
 
 
 
 Overview:
 
 
 The Patient Access &amp; Eligibility Specialist plays a critical role in supporting patient access to care management services by ensuring accurate insurance verification, confirming program eligibility, and assisting patients through administrative intake processes.
 
 
 This role serves as the front door to the care management program, helping identify eligible patients for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and other virtual care services.
 
 
 The Patient Access &amp; Eligibility Specialist verifies insurance coverage, confirms patient eligibility, answers incoming patient calls, manages voicemail communications, and ensures accurate documentation within electronic medical record (EMR) systems and care management platforms.
 
 
 The ideal candidate has strong technical proficiency, excellent communication skills, and the ability to navigate multiple healthcare systems efficiently while delivering a professional and compassionate patient experience.
 
 
 Reports To: Nursing Manager
 
 
 Department: Clinical Operations
 
 
 
 Job Description
 
 :
 
 
 
 Patient Call Management &amp; Communication
 
 
 
 <ul>
 <li>
 Answer incoming patient calls and provide professional, courteous assistance.
 </li>
 <li>
 Respond to patient inquiries related to care management programs and services.
 </li>
 <li>
 Manage voicemail systems by reviewing incoming messages and ensuring calls are routed to the appropriate team member or department.
 </li>
 <li>
 Coordinate call routing to Care Coordinators, Enrollment Specialists, or other staff based on patient needs.
 </li>
 <li>
 Ensure patient messages are handled promptly and accurately to support timely follow-up.
 </li>
 <li>
 Document all patient communications within the care management platform.
 </li>
 <li>
 Maintain strict adherence to HIPAA and patient privacy standards during all interactions.
 
 
 </li>
 </ul>
 
 Insurance Verification &amp; Eligibility Determination
 
 
 
 <ul>
 <li>
 Verify patient insurance coverage and eligibility for care management programs.
 </li>
 <li>
 Confirm payer requirements for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and other services.
 </li>
 <li>
 Review patient benefits, coverage status, and eligibility criteria.
 </li>
 <li>
 Identify patients who qualify for enrollment in care management programs.
 </li>
 <li>
 Document eligibility verification results in the appropriate systems.
 
 
 </li>
 </ul>
 
 Enrollment Pipeline Support
 
 
 
 <ul>
 <li>
 Prepare eligible patient lists for the Enrollment team by verifying eligibility and insurance coverage.
 </li>
 <li>
 Flag patients who meet program criteria for outreach and enrollment.
 </li>
 <li>
 Support enrollment readiness by ensuring patient demographic and insurance data is accurate.
 </li>
 <li>
 Communicate eligibility findings with Enrollment Specialists to support effective patient outreach.
 </li>
 <li>
 Assist with administrative preparation for patient enrollment processes.
 
 
 </li>
 </ul>
 
 Administrative &amp; Platform Support
 
 
 
 <ul>
 <li>
 Maintain accurate patient demographic and insurance information within care management platform.
 </li>
 <li>
 Assist with patient record updates and administrative workflows related to care management services.
 </li>
 <li>
 Ensure documentation is accurate, complete and compliant with program requirements.
 </li>
 <li>
 Support internal teams with patient information verification and administrative tasks.
 
 
 </li>
 </ul>
 
 Technology &amp; Data Accuracy
 
 
 
 <ul>
 <li>
 Utilize electronic medical records (EMR), care management platforms, and telephony systems to support patient access workflows.
 </li>
 <li>
 Demonstrate strong technical proficiency when navigating multiple healthcare platforms simultaneously.
 </li>
 <li>
 Maintain a high level of accuracy when entering patient information into healthcare systems.
 </li>
 <li>
 Assist with resolving minor data discrepancies and escalate system issues when necessary.
 
 
 </li>
 </ul>
 
 Qualifications and Skills Required:
 
 
 
 <ul>
 <li>
 1&ndash;3 years of experience in healthcare administration, patient access, insurance verification, or care coordination support
 </li>
 <li>
 Experience verifying health insurance eligibility and benefits
 </li>
 <li>
 Familiarity with Chronic Care Management (CCM), Remote Patient Monitoring (RPM), or population health programs preferred
 </li>
 <li>
 Experience working with electronic medical record (EMR) systems
 </li>
 <li>
 Strong technical proficiency and ability to learn new healthcare platforms quickly
 </li>
 <li>
 Experience handling patient phone calls in a professional healthcare environment
 </li>
 <li>
 Excellent verbal communication and patient engagement skills
 </li>
 <li>
 Strong organizational and time management abilities
 </li>
 <li>
 High attention to detail and documentation accuracy
 
 
 </li>
 </ul>
 
 Competencies:
 
 
 
 Competency
 
 
 Definition
 
 
 Patient Communication
 
 
 Provides clear, compassionate communication when assisting patients.
 
 
 Insurance Verification
 
 
 Demonstrates strong understanding of insurance coverage and eligibility processes.
 
 
 Technical Acumen
 
 
 Navigates EMR systems and healthcare technology platforms efficiently.
 
 
 Attention to Detail.
 
 
 Ensures accuracy in documentation and patient data entry.
 
 
 Compliance Awareness
 
 
 Maintains HIPAA compliance and proper handling of protected health information.
 
 
 Organization
 
 
 Manages multiple tasks and systems effectively in a fast-paced environment.
 
 
 Collaboration
 
 
 Works closely with Enrollment Specialists, Care Coordinators, and operations staff.
 
 
 Key Performance Indicators (KPIs)
 
 
 <ul>
 <li>
 Insurance verification accuracy rate
 </li>
 <li>
 Eligibility verification turnaround time
 </li>
 <li>
 Patient call response quality and timeliness
 </li>
 <li>
 Voicemail response and routing accuracy.
 
 
 </li>
 </ul>
 
 Work Location, Shift &amp; Schedule
 
 
 
 This position is remote (please see remote requirements below). Shifox/Alopex employees work Monday-Friday r according to the business hours of client practices.
 
 
 
 Remote Position Requirements:
 
 
 
 Reliable and stable Internet &ndash; all programs used by
 
 Patient Access &amp; Eligibility Specialist
 
 are internet based. A quiet and professional work environment suitable for speaking with patients about sensitive information and Protected Health Information (PHI), free of distractions.
 
 
 
 Compensation
 
 :
 
 
 Contractors are paid on a monthly basis, see below.
 
 
 Rate $17.00-$18.00 per hour
 
 
 Powered by JazzHR
 
 
 F9yYuzQP2P
</div>

H.K. TECHNOLOGIES LTD

Job Overview:We are seeking a detail-oriented Dental Insurance Eligibility Specialist with at least 1 year of experience in the US healthcare industry. The ideal candidate will be responsible for verifying dental insurance coverage, benefits, and eligibility to support accurate billing and seamless patient care coordination.This role requires strong knowledge of US dental insurance processes, excellent communication skills, and the ability to work efficiently in a fast-paced environment.Key Responsibilities:<ul><li>Verify patient dental insurance eligibility, benefits, and coverage details</li><li>Contact insurance providers via phone, IVR systems, or online portals</li><li>Review and interpret dental plans including PPO, HMO, DMO, and indemnity plans</li><li>Confirm coverage details such as co-pays, deductibles, waiting periods, and annual maximums</li><li>Accurately enter and update patient insurance information in systems</li><li>Communicate verification results to dental offices, billing teams, or internal stakeholders</li><li>Identify and resolve discrepancies in insurance information or coverage gaps</li><li>Support billing teams by providing accurate eligibility data for claims processing</li><li>Maintain proper documentation for audit and compliance purposes</li><li>Ensure strict adherence to HIPAA regulations and data confidentiality standards</li><li>Meet daily productivity and quality benchmarks</li></ul>Required Qualifications:<ul><li>Minimum 1 year of experience in dental insurance verification (US healthcare)</li><li>Strong understanding of dental terminology and insurance workflows</li><li>Familiarity with US dental insurance plans (PPO, HMO, DMO, indemnity)</li><li>Excellent English communication skills (verbal and written)</li><li>Strong attention to detail and problem-solving skills</li><li>Proficiency in MS Office and data entry systems</li><li>Ability to work independently and manage workload efficiently</li><li>Experience with dental practice management software (e.g., Dentrix, Eaglesoft, Open Dental)</li><li>Knowledge of Revenue Cycle Management (RCM) processes</li><li>Experience handling US-based dental providers or DSOs</li></ul>What We Offer:<ul><li>Market-competitive salary</li><li>Performance-based growth and career advancement opportunities</li><li>On-the-job training and continuous learning programs</li><li>Paid Leaves (Annual, Casual, &amp; Sick)</li><li>Provident Fund (if applicable)</li></ul>Job Type: Full-time (Night Shift) Location: In-person (Lahore)Job Type: Full-timePay: From Rs50,000.00 per monthWork Location: In person

Dental Insurance Eligibility Specialist

Mac Care

We are seeking a detail-oriented and analytical Insurance Verification &amp; 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 &amp; Eligibility:<ul><li>Verify patient insurance coverage (commercial, Medicare, Medicaid, and other payers) prior to appointments or services.</li><li>Confirm benefits, deductibles, co-insurance, co-payments, policy limitations, and exclusions.</li><li>Review and interpret payer portals, EHR systems, and clearinghouses for real-time eligibility updates.</li><li>Ensure accurate documentation of verified benefits in the system.</li></ul>Authorization &amp; Pre-Certification:<ul><li>Obtain prior authorizations as required by payers for specific procedures, diagnostic tests, or treatments.</li><li>Communicate with insurance companies to resolve authorization discrepancies or incomplete information.</li><li>Track authorization status and follow up to secure approvals before service dates.</li></ul>Communication &amp; Coordination:<ul><li>Coordinate with providers, schedulers, and billing teams to ensure all insurance-related requirements are met prior to patient appointments.</li><li>Communicate coverage issues, payer requirements, or eligibility concerns to relevant teams promptly.</li><li>Provide guidance to patients regarding coverage expectations, if required.</li></ul>Documentation &amp; Data Accuracy:<ul><li>Maintain complete and accurate patient insurance information in the practice management or billing system.</li><li>Document all interactions, verification results, and authorization details in compliance with organizational policies.</li><li>Identify and correct missing or outdated insurance information.</li></ul>Denial Prevention &amp; RCM Support:<ul><li>Identify potential coverage issues that may result in claim denials.</li><li>Work closely with AR and Billing teams to support clean claim submission.</li><li>Review denial trends related to coverage or eligibility and provide feedback to the team.</li></ul>Qualifications &amp; Requirements:Education:<ul><li>Bachelor&rsquo;s degree preferred, but not mandatory.</li><li>High school diploma or equivalent required.</li></ul>Experience:<ul><li>1&ndash;2 years of experience in U.S. Healthcare Revenue Cycle Management (Insurance Verification, Eligibility, Front-End RCM).</li><li>Experience with commercial insurances, Medicare, Medicaid, and managed care plans preferred.</li><li>Familiarity with EMR systems, clearinghouses, and payer portals.</li></ul>Job Type: Full-timeWork Location: In person

Insurance Verification-Eligibility Specialist

Top Line Resource Group (TLRG)

Location: DHA Phase 8, Lahore [Onsite]Employment Type: Full-timeWork Timing: 05 PM &ndash; 02 AM Pakistan Time (US Business Hours)Job OverviewTopline Resource Group (TLRG) is seeking a dedicated Eligibility &amp; Authorization Specialist to manage the critical front-end operations for our US-based healthcare clients. This role is focused entirely on securing the financial foundation of the practice by ensuring every patient has active coverage and every procedure has the required clinical approval before services are rendered.Key Responsibilities<ul><li>Verify patients' insurance coverage and eligibility in real-time to ensure policies are active and services are covered on the specific Date of Service (DOS).</li><li>Obtain pre-authorizations from insurance companies for medical procedures and treatments.</li><li>Communicate directly with patients regarding their insurance status, coverage specifics, and any required actions or out-of-pocket responsibilities.</li><li>Maintain accurate and meticulous records of insurance verifications and authorizations, including representative names and unique reference numbers for audit trails.</li><li>Collaborate with healthcare providers to ensure all necessary clinical information, physician notes, and CPT/ICD-10 codes are obtained for successful pre-authorizations.</li><li>Monitor and follow up on pending authorizations daily to ensure timely processing and stay within the 7&ndash;10 day payer response window.</li><li>Analyze insurance benefits to identify exact copays, unmet deductibles, and co-insurance percentages to ensure accurate front-end collections.</li><li>Identify if the provider is in-network or out-of-network and determine if specific plan tiers (HMO/EPO) require a PCP referral before the visit.</li><li>Stay up to date with insurance policies, CMS regulations, and HIPAA guidelines to ensure 100% compliance across all US healthcare accounts.</li><li>Track and manage KPIs, including the clean claim rate and authorization turnaround time, to reduce AR aging and increase collection rates.</li></ul>Required Qualifications<ul><li>3+ years of experience in US Medical Billing, specifically focused on Front-End operations (Eligibility and Authorizations).</li><li>Expert-level familiarity with CPT, ICD-10, and HCPCS codes and their specific relationship to authorization requirements.</li><li>Deep understanding of US insurance plans, including Medicare, Medicaid, HMO, PPO, and Commercial plans.</li><li>Hands-on experience with EHR/EMR systems, Practice Management software, and major US payer portals (Availity, Navinet, etc.).</li><li>Excellent verbal and written English communication skills for professional interaction with US insurance companies and clinical teams.</li><li>Strong analytical ability to interpret Verification of Benefits (VOB) reports and payer medical necessity criteria to resolve issues before service delivery.</li></ul>Pay: Rs100,000.00 - Rs125,000.00 per monthExperience:<ul><li>eligibility &amp; authorization: 2 years (Required)</li></ul>Work Location: In person

Eligibility & Authorization Specialist

Search 10000+ Eligibility specialist jobs near you this April. New roles added regularly across leading industries. Apply today.

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