Eligibility and Verifications Specialist
1 day ago
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.
- 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
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