Eligibility & Benefits Verification Specialist

AuraRCM & Consulting Inc.; Chennai District; On-site; INR 400,000 - 600,000; Full time

Job summary

AuraRCM & Consulting Inc. in Chennai, India, seeks a Verification Specialist to ensure accurate patient insurance verification, benefit capture, and documentation across payer portals and EMR systems.

The role emphasizes HIPAA compliance, prompt communication of coverage issues to providers, and adherence to client turnaround times, with a focus on productivity and high-quality verification.

Qualifications

• Verify patient insurance eligibility and coverage using payer portals and EMR systems.
• Capture specific benefit details including co-pays, deductibles, coinsurance, and out-of-pocket max.
• Accurately document verification results, reference numbers, and contacts in the client PM/EMR.
• Confirm service specifics like referrals, pre-authorization, and covered services.

Responsibilities

• Timely verify patient insurance eligibility, coverage status, and benefit details.
• Obtain and document benefit information including co-pays, deductibles, coinsurance, and out-of-pocket maximums.
• Accurately document all verification results in the EMR/PM system.
• Confirm benefit limitations, referral requirements, pre-authorization needs, and covered services.

Skills

Verification Execution

Benefit Detail Capture

Documentation

Service Specifics

Communication

Workflow Management

Compliance

Quality & Productivity

Job description

• Verification Execution: Timely verify patient insurance eligibility, coverage status, and benefit details using payer websites/portals, electronic verification tools, and direct calls to insurance carriers.
• Benefit Detail Capture: Obtain and document specific benefit information, including co-pays, deductibles, coinsurance amounts, out-of-pocket maximums, and in network/out-of-network benefits for the services scheduled.
• Documentation: Accurately and comprehensively document all verification results, reference numbers, contact details, and confirmation details in the client's practice management system or EMR.
• Service Specifics: Confirm benefit limitations, referral requirements, pre-authorization needs, and covered services specific to the scheduled patient encounter (e.g., lab work, specialty visits).
• Communication: Communicate any coverage issues or discrepancies back to the client/provider teams promptly to ensure accurate patient financial counseling.
• Workflow Management: Prioritize verification tasks based on appointment schedules and urgency, ensuring adherence to client turnaround time (TAT) requirements.
• Compliance: Ensure all verification activities adhere to HIPAA guidelines and client specific protocols.
• Quality & Productivity: Meet and maintain high daily productivity and quality targets related to verification accuracy.