Medical Billing Claims Adjudicator
6 days ago
The Benefits Verification specialist plays a critical role in supporting healthcare providers, treatment centers, and billing departments by verifying patients' insurance coverage and benefits. This position ensures accurate and timely verification of insurance information to facilitate smooth admissions, billing, and claims processes.
Key Responsibilities:- Verify Patient Insurance Benefits
- Contact insurance companies via phone or portals to verify patient coverage and eligibility.
- Gather detailed information on covered services, copays, deductibles, and prior authorization requirements.
- Document all benefit details in the EHR or billing system.
- Submit Authorization Requests
- Prepare and submit prior authorization requests including relevant clinical documentation.
- Follow up on pending authorizations with insurance carriers to ensure timely approvals.
- Maintain records of submitted authorizations.
- Track Authorization Expiry and Renewals
- Monitor expiration dates for existing authorizations.
- Initiate renewal processes prior to expiration to avoid service disruptions.
- Notify teams of any issues or lapses.
- Coordinate with Clinical Staff
- Request and compile necessary clinical documentation.
- Communicate with clinicians to ensure documents are up to date and compliant.
- Ensure compliance and accuracy.
- Maintain confidentiality and comply with data protection policies.
- At least 2 years of proven experience in medical billing, insurance verification, or healthcare administration required.
- Strong knowledge of insurance terminology and benefit structures.
- Excellent verbal and written communication skills.
- Detail-oriented with ability to multitask and manage time effectively.
- Proficient in using spreadsheets, CRM tools, and insurance portals.
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