We are looking for Eligibility & Verification Associates to join our US Healthcare (RCM) team. The ideal candidate should have experience in verifying patient insurance details, checking coverage, understanding advantages, and coordinating with payers through calls and online portals.
Key Responsibilities
Verify patient eligibility and benefits through:
- Insurance portals
- Phone calls to insurance companies
- Clearinghouse tools
- Validate coverage for:
- Outpatient/Inpatient services
- Therapies
- Specialist visits
- Document accurate benefit information in the system (copay, coinsurance, deductible, plan type, etc.)
- Identify insurance-related issues (inactive policy, wrong payer, COB, demographic mismatch)
- Coordinate with internal teams for missing/incorrect information
- Maintain accuracy, productivity, and turnaround time as per client requirements
- Ensure HIPAA compliance and patient data confidentiality
Required Skills
- Good communication skills (English – verbal & written)
- Experience with insurance portals (Availity, ECW, Athena, OneSource, etc.)
Understanding of:
- Insurance types (PPO, HMO, Medicare, Medicaid)
- Eligibility terms (deductible, OOP, copay, coinsurance)
- EOB/ERA basics
- Attention to detail and good analytical ability
- Ability to work in a fast-paced US healthcare environment