The Role
Verify patient insurance eligibility, benefits, co-pays, deductibles, pre-authorizations and referrals via payer portals or calls. Update patient demographics and insurance data, resolve discrepancies, communicate with insurers, coordinate with internal teams, maintain SLA productivity/quality, document verifications, and escalate complex issues.
Summary Generated by Built In
- Verify patient insurance eligibility, benefits, and coverage details through payer portals or calls
- Check co-pay, co-insurance, deductibles, and out-of-pocket expenses
- Confirm pre-authorization and referral requirements before services
- Update patient demographic and insurance information accurately in the system
- Identify discrepancies in insurance details and resolve them proactively
- Communicate with insurance providers for clarifications and additional details
- Coordinate with internal teams (front office, billing, AR) to ensure accurate processing
- Maintain daily productivity and quality targets as per SLA
- Document verification details and maintain audit-ready records
- Escalate complex cases or unresolved issues to the supervisor in a timely manner
Skills Required
- Verify patient insurance eligibility, benefits, and coverage details
- Check co-pay, co-insurance, deductibles, and out-of-pocket expenses
- Confirm pre-authorization and referral requirements before services
- Update patient demographic and insurance information accurately in the system
- Identify discrepancies in insurance details and resolve them proactively
- Communicate with insurance providers for clarifications and additional details
- Coordinate with internal teams (front office, billing, AR) to ensure accurate processing
- Maintain daily productivity and quality targets as per SLA
- Document verification details and maintain audit-ready records
- Escalate complex cases or unresolved issues to the supervisor in a timely manner
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The Company
What We Do
GetixHealth provides hospitals, clinics, university medical centers, and other healthcare facilities across the United States with comprehensive revenue cycle management (RCM) services. Our services are customized to the needs of our client and can either include all facets of the front and back office revenue cycle or a mixture of these services, including but not limited to: medical coding and billing, claims management, insurance eligibility services, medicaid/medicare specialized services, and self pay and bad debt collections.
