About the role

OptiClaim Business Solutions is hiring a Hospital Patient Access Specialist to handle back-end eligibility and benefit verification (EVBV) for US hospital clients. You will make sure every account has the right patient, the right insurance and the right payer order before it bills, so claims are not denied for registration errors.

Shift: US hours (night shift IST)

Departments covered: Emergency, inpatient, observation, outpatient clinics, lab and radiology

What you will do

Eligibility and benefit verification

- Verify insurance eligibility for every insured patient account through OneSource, Availity, payer portals and state Medicaid or Medicare portals
- Record the eligibility reference number and mark the account as verified in the hospital system
- Capture benefits: copay, coinsurance, deductible remaining and out of pocket maximum
- Keep only active plans on the account, and end date or remove inactive and duplicate plans

Insurance discovery

- Find coverage for self-pay patients and for patients who left before full registration
- Check prior visits for insurance the patient had on file
- Flag likely Medicaid eligible patients to the financial counseling team

Payer order and special cases
- Set primary and secondary payers correctly (coordination of benefits)
- Confirm the Medicare Secondary Payer (MSP) questionnaire is completed for Medicare patients
- Tell Medicare and Medicare Advantage plans apart
- Capture auto and workers' compensation carriers and claim numbers for accident and injury visits
- Confirm the guarantor and subscriber for minors

Authorization and notification

- Check whether prior authorization or a referral is required for scheduled services
- Track payer notification for inpatient admissions and observation stays within the payer's window

Quality review and error worklists
- Review the previous day's registrations against a checklist and log every error




- Work the daily interface error report so accounts with missing or rejected insurance are fixed the same day
- Route errors to the right owner: data entry errors back to the registrar, plan code errors to the application analysts

Denial prevention

- Review eligibility, COB and registration denials and identify the root cause
- Prepare weekly error and denial summaries by error type and by registrar
- Suggest checklist and process changes that stop repeat errors

What you need

- At least 3 years of US hospital patient access or EVBV experience
- Hands-on experience with insurance discovery for emergency or self-pay patients
- Working knowledge of Medicare, Medicare Advantage, Medicaid and commercial plans
- Clear understanding of coordination of benefits and the MSP questionnaire
- Experience with at least one eligibility tool such as Experian OneSource or Availity
- Experience with at least one hospital registration or billing system such as Epic, Cerner, Meditech or STAR
- High accuracy in data entry, with no placeholder or guessed values
- Good written English for notes and summaries
- Willingness to work a steady US hours night shift
- A graduate degree in any discipline

Valuable to have

- Experience with Cerner (FirstNet, PowerChart) or STAR
- Experience with the Illinois Medicaid portal or NGSConnex
- Prior authorization and referral experience
- Experience doing registration QA audits or denial root cause analysis
- NAHAM CHAA certification or HFMA Patient Access training

How we measure success

- Registration accuracy rate
- Share of insured accounts with eligibility verified
- Self-pay accounts converted to a billable payer
- Interface errors fixed the same day
- Eligibility and COB denials on accounts you worked
- Accounts worked per shift

Interview process

- Shortlisted candidates will have a 30 minute interview on Microsoft Teams, including a short practical exercise reviewing sample registrations.

📌 Hospital Patient Access Specialist (EVBV) (India)
🏢 OptiClaim
📍 India