Healthcare Insurance Eligibility and Benefits Specialist-FT Remote

• Verify patient insurance coverage through payer websites, clearinghouses, and direct communication with insurance representatives.
• Confirm eligibility, benefits, coverage limitations, copayments, coinsurance, deductibles, and out-of-pocket responsibilities.
• Identify primary, secondary, and tertiary insurance coverage.
• Review policy effective dates and ensure insurance information is current and accurate.

• Determine coverage for scheduled procedures, treatments, diagnostic services, and specialty care.
• Verify benefit limitations, exclusions, medical necessity requirements, and referral requirements.
• Communicate benefit information to patients, providers, and internal teams.
• Estimate patient financial responsibility

• Accurately document eligibility and benefits verification findings within practice management or electronic health record (EHR) systems.
• Maintain detailed records of payer contacts, reference numbers, and verification outcomes.
• Ensure compliance with HIPAA, organizational policies, and payer guidelines.
• Support audit and quality assurance activities related to insurance verification processes.

• Collaborate with scheduling, registration, billing, and coding teams to prevent claim denials related to eligibility issues.
• Assist with denial prevention initiatives and insurance-related problem resolution.
• Identify trends impacting reimbursement and communicate findings to management.

• High school diploma or equivalent.
• Minimum 1–3 years of healthcare insurance verification, eligibility, benefits investigation, patient access, or revenue cycle experience.
• Knowledge of commercial insurance, Medicare, Medicaid, Managed Care, and government healthcare programs.
• Understanding of insurance terminology, including deductibles, copayments, coinsurance, referrals, and prior authorizations.
• Proficiency with payer portals, clearinghouse tools, EHR systems, and Microsoft Office applications.

• Associate's or Bachelor's degree in Healthcare Administration, Business, or related field.
• Certification in healthcare revenue cycle, patient access, or medical office administration.
• Experience in specialty healthcare services, hospital, physician practice, or ambulatory care settings.

• Strong knowledge of healthcare insurance verification and benefits investigation processes.
• Excellent verbal and written communication skills.
• Strong analytical and problem-solving abilities.
• Exceptional attention to detail and organizational skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Customer-service-focused approach with professional telephone etiquette.
• Ability to maintain confidentiality and handle sensitive patient information.

• Eligibility verification accuracy rate.
• Reduction in insurance-related claim denials.
• Timeliness of benefit and authorization verification.
• Patient satisfaction related to insurance and financial communications.
• Compliance with organizational and payer requirements.

• Remote work environment.
• Frequent use of computer systems, payer portals, and telephone communication.
• May require interaction with insurance carriers, and revenue cycle personnel throughout the workday.

Powered by JazzHR