Eligibility & Benefits Verification Specialist

AuraRCM; Chennai District; On-site; INR 300,000 - 540,000; Full time

Job summary

A healthcare solutions company in Chennai is looking for a candidate to manage patient insurance verification, document benefits, and ensure compliance with relevant guidelines. The ideal applicant will have experience in handling insurance queries, possess good communication skills, and demonstrate attention to detail. This role is crucial for providing accurate patient financial counseling and ensuring adherence to turnaround time requirements for verification tasks.

Qualifications

• Experience in patient insurance verification processes.
• Strong communication skills for liaising with clients and providers.
• Attention to detail and ability to document accurately.

Responsibilities

• Verify patient insurance eligibility and coverage status.
• Document patient benefit information accurately.
• Communicate coverage issues or discrepancies promptly.
• Ensure compliance with HIPAA guidelines.
• 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.

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.

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