Eligibility Verification (IV) Executive - US Healthcare - Noida

Job Summary:

We are seeking a detail-oriented and proactive Eligibility Verification Executive to join our Healthcare Revenue Cycle Management (RCM) team. The primary responsibility of this role is to verify insurance eligibility and benefits for patients, ensuring accurate billing and reimbursement in accordance with US healthcare regulations. The ideal candidate will have a strong understanding of insurance verification processes, excellent communication skills, and a commitment to delivering exceptional customer service.

Key Responsibilities:

- Verify insurance coverage and benefits for patients prior to services rendered.

- Contact insurance companies, healthcare providers, and patients to gather necessary information for verification.

- Review insurance policies to determine coverage limitations, exclusions, and coordination of benefits.

- Update patient records and billing systems with verified insurance information accurately and promptly.

- Communicate with patients regarding their insurance coverage details, copayments, deductibles, and any out-of-pocket expenses.

- Collaborate with healthcare providers, billing specialists, and insurance companies to resolve eligibility-related issues.

- Stay updated on changes in insurance regulations, policies, and procedures affecting eligibility verification.

- Generate reports and maintain documentation of eligibility verification activities.

Qualifications:

- Proven experience 1 year in eligibility verification within a US healthcare setting, preferably in revenue cycle management or medical billing.

- Knowledge of insurance plans, medical terminology, CPT, ICD-10, and HCPCS coding systems.

- Strong communication skills with the ability to effectively interact with patients, insurance companies, and healthcare providers.

- Detail-oriented with excellent analytical and problem-solving abilities.

- Proficiency in using healthcare information systems and billing software (e.g., Epic, Cerner).

- Ability to prioritize tasks and work independently in a fast-paced environment.