Insurance Eligibility Specialist - RCM

The Insurance Eligibility Specialist will play a crucial role in the revenue cycle management process by verifying patient insurance coverage and benefits, ensuring accurate patient information, and assisting with the resolution of insurance-related issues. This position requires a thorough understanding of insurance policies, and eligibility requirements, and the ability to communicate effectively with patients, insurance companies, and internal departments.

Key Responsibilities:

Verify patient insurance coverage and eligibility prior to services being rendered.
Accurately input and update patient insurance information in the electronic health record (EHR) system.
Communicate with insurance companies to resolve coverage issues and obtain necessary authorizations.
Assist patients with understanding their insurance benefits and financial responsibilities.
Collaborate with the billing department to ensure accurate and timely claim submission.
Monitor and follow up on pending insurance verifications and authorizations.
Maintain confidentiality of patient information in compliance with HIPAA regulations.
Provide exceptional customer service to patients, healthcare providers, and insurance representatives.
Identify and report trends or issues in insurance verification processes to management.
Stay informed about changes in insurance policies, procedures, and industry regulations.

Qualifications:

Minimum of 1 year of experience in insurance verification, eligibility, or related role in a healthcare setting.
Strong knowledge of insurance policies, including Medicare, Medicaid, and commercial insurance plans.
Proficiency in using EHR systems and insurance verification tools.
Excellent communication and interpersonal skills.
Strong attention to detail and organizational skills.
Ability to work independently and as part of a team in a fast-paced environment.
Knowledge of medical terminology and coding (CPT, ICD-10) is a plus.