Eligibility and Benefits Specialist

Job Summary:

We are seeking a detail-oriented Insurance Verification Specialist to support our healthcare operations by ensuring accurate and timely insurance verification for patients across multiple clinic locations. The ideal candidate will possess a strong understanding of medical insurance benefits, excellent organizational skills, and the ability to manage a high-volume workload while maintaining accuracy.

Key Responsibilities:

• Verify insurance eligibility and benefits for a minimum of 200 patients per day using payer portals and other verification tools.
  
• Review and interpret medical insurance benefits, coverage limitations, authorizations, and eligibility requirements.
  
• Document and maintain accurate insurance verification notes and pertinent patient information within the system.
  
• Proactively identify and escalate insurance issues that may impact patient scheduling, treatment, or clinic operations.
  
• Collaborate with billing, scheduling, and clinical teams to resolve insurance-related concerns efficiently.
  
• Update and maintain patient records, including insurance details, demographics, and other information required for accurate claims submission.
  
• Create new patient cases and update existing cases within electronic medical records (EMR) or patient management systems.
  
• Ensure compliance with organizational policies, payer guidelines, and HIPAA regulations regarding patient information.

Qualifications:

• Previous experience in insurance verification, healthcare administration, medical billing, or a related field preferred.
• Working knowledge of medical insurance plans, benefits, eligibility verification, and claims processes.
• Strong attention to detail with the ability to manage large volumes of work accurately and efficiently.
• Excellent communication and problem-solving skills.
• Proficiency in Microsoft Office applications, including Outlook, Excel, and Word.
• Experience with EMR/EHR systems and insurance verification portals is an advantage.
  

Preferred Skills:

• Ability to work independently and meet daily productivity targets.
  
• Strong organizational and time-management skills.
  
• Experience handling multiple insurance carriers and payer systems.
  
• Familiarity with healthcare terminology and revenue cycle processes.

Performance Expectations

• Consistently meet or exceed daily insurance verification productivity goals.
• Maintain high accuracy rates in documentation and patient record updates.
• Effectively communicate and resolve insurance issues to minimize delays in patient care and clinic operations.