Eligibility and Verifications Specialist

4 weeks ago

Cebu City, Central Visayas, Philippines CallTek Full time
Overview

Summary: An Eligibility and Verifications Specialist's main responsibilities include verifying insurance coverage, estimating patient cost-sharing responsibilities, and determining the coverage of specific services, devices, and treatment modalities under patients' insurance plans. Your expertise will ensure accurate billing, streamline administrative processes, and enhance patient satisfaction. Reports to: Team Lead, Patient Benefits and Eligibility.

Key Responsibilities
  • Insurance Verification: Verify patients' insurance coverage and eligibility through electronic systems or direct communication with insurance providers. Review insurance policies, benefit summaries, and pre-authorization requirements to determine coverage for medical services, devices, and treatment modalities. Update patient records with verified insurance information and coverage details.
  • Cost Estimation: Estimate patients' out-of-pocket expenses, including co-pays, deductibles, and co-insurance, for planned medical services or procedures. Communicate cost estimates to patients, explaining their financial responsibilities and payment options.
  • Coverage Determination: Investigate and determine if specific medical services, devices, or treatment modalities are covered under patients' insurance plans. Liaise with insurance companies to obtain pre-authorizations and prior approvals for procedures or treatments when necessary. Advise healthcare providers and patients on coverage limitations and alternative payment options for non-covered services.
  • Documentation and Reporting: Maintain accurate records of insurance verifications, coverage determinations, and patient cost estimates. Generate reports on insurance verification outcomes, coverage trends, and reimbursement issues to support decision-making and process improvement.
  • Collaboration and Communication: Collaborate with healthcare providers, billing staff, and administrative personnel to ensure seamless coordination of insurance verification processes. Communicate effectively with patients, answering their insurance-related inquiries and helping them understand their coverage options.
Qualifications
  • Strong verbal and written communication skills
  • Expert understanding of insurance benefits and coverage
  • Understanding of insurance web portals
  • Problem-solving mindset
  • Minimum 2 years of experience in benefits and verification
  • Resolution-focused mindset
#J-18808-Ljbffr

  • Eligibility and Verifications Specialist

    2 weeks ago

    Cebu City, Central Visayas, Philippines Staff4Me Full time

    Summary:An Eligibility and Verifications Specialist's main responsibility is verifying insurance coverage, estimating patient cost-sharing responsibilities, and determining the coverage of specific services, devices, and treatment modalities under patients' insurance plans. Your expertise will ensure accurate billing, streamline administrative processes, and...

  • Insurance Verification Specialist

    2 weeks ago

    Cebu City, Central Visayas, Philippines beBeeVerification Full time ₱49,000 - ₱74,000

    Job Title: Insurance Verification SpecialistAbout the Role:The Insurance Verification Specialist plays a pivotal role in ensuring seamless patient admissions, billing, and claims processes by verifying insurance coverage and benefits.This position requires strong communication skills, medical terminology knowledge, and an understanding of insurance...

  • Verification and Claims Specialist

    2 weeks ago

    Cebu City, Central Visayas, Philippines beBeeVerification Full time ₱3,500,000 - ₱5,000,000

    Job OverviewAs a Verification and Claims Specialist, you will play a critical role in confirming insurance coverage, estimating patient financial responsibilities, and determining the coverage of specific services, devices, and treatment modalities under patients' insurance plans.This position requires strong analytical skills, attention to detail, and...

  • Lead Verification Specialist

    2 weeks ago

    Cebu City, Central Visayas, Philippines beBeeVerification Full time $40,000 - $60,000

    Lead Verification Support Specialist OpportunityEmbark on a rewarding career in a multicultural and multilingual environment as a Lead Verification Support Specialist for a prestigious brand.Job SummaryConfirm lead interest by establishing contact and verifying informationForward qualified inquiries to authorized retailersUpdate and categorize leads within...

  • Insurance Verification Expert

    2 weeks ago

    Angeles City, Central Luzon, Philippines beBeeInsurance Full time ₱600,000 - ₱800,000

    Job Title: Insurance Verification ExpertWe are seeking an experienced Insurance Verification Specialist with expertise in Neurology and Allergy practices.The role involves verifying patient insurance coverage, benefits, and eligibility to ensure smooth billing and claims processing.Key Responsibilities:Verify patient insurance eligibility, coverage, and...

  • Patient Eligibility Specialist

    2 weeks ago

    Angeles City, Central Luzon, Philippines beBeeAuthorization Full time ₱499,999 - ₱699,999

    The Patient Authorization Coordinator plays a vital role in facilitating interactions with various stakeholders, including clinical sales specialists, physicians, nurses, and case managers. This position is responsible for ensuring the ongoing verification and eligibility of patients at a corporate office.Key ResponsibilitiesVerify patient authorization...

  • Healthcare Insurance Verification Specialist

    2 weeks ago

    Tarlac City, Central Luzon, Philippines beBeeInsuranceVerification Full time ₱600,000 - ₱1,000,000

    We are seeking a detail-oriented professional with expertise in Neurology and Allergy practices.The role involves verifying patient insurance coverage, benefits, and eligibility to ensure smooth billing and claims processing. If you have strong experience with NextGen software and a solid background in healthcare insurance verification, this is an excellent...

  • Verification Specialist

    1 week ago

    Angeles City, Central Luzon, Philippines SuperStaff Full time ₱25,000 - ₱50,000 per year

    Position SummaryThe Verification Specialist ensures the accuracy of patient demographic and insurance information to support efficient and compliant physical therapy services. This role involves regular communication with internal teams and patients, verifying insurance benefits, and ensuring HIPAA compliance. The position is key to maintaining smooth...

  • Verification Specialist

    2 weeks ago

    Angeles City, Central Luzon, Philippines SuperStaff Full time ₱250,000 - ₱500,000 per year

    Position SummaryThe Verification Specialist ensures the accuracy of patient demographic and insurance information to support efficient and compliant physical therapy services. This role involves regular communication with internal teams and patients, verifying insurance benefits, and ensuring HIPAA compliance. The position is key to maintaining smooth...

  • Healthcare Billing Specialist

    2 weeks ago

    Cebu City, Central Visayas, Philippines beBeeMedical Full time ₱20,000 - ₱33,000

    We are seeking a dedicated medical biller to join our team. This full-time, mid-level role supports US healthcare client revenue cycle management using the Athena billing software.The ideal candidate will have extensive hands-on experience with Athena billing software/EMR and a solid understanding of US healthcare insurance guidelines and medical billing...