Eligibility and verification calling specialist ( Provider side )

The Senior Executive Benefits Coordination is responsible for end-to-end insurance eligibility verification and benefits coordination activities. The role focuses on ensuring accurate and timely verification, efficient handling of client requirements, and adherence to productivity, quality, and SLA benchmarks.

The position plays a key role in supporting seamless workflow execution, resolving verification-related issues, and maintaining effective communication with internal teams and clients.

Key Responsibilities

1. Insurance Verification & Operations

• Perform insurance eligibility and benefits verification accurately within defined TAT.
  • Complete advance-day verification requirements as per client expectations.
  • Review and resolve verification-related denials and rejections.
  • Escalate complex issues or discrepancies to the Team Leader as required.
  • Ensure all assigned tickets are completed within SLA timelines.

2. Production & Workflow Management

• Achieve 100% daily productivity targets for verification tasks.
  • Ensure high accuracy in verification details with minimal errors.
  • Maintain adherence to defined TAT and SLA benchmarks.
  • Manage workload efficiently to ensure timely completion of deliverables.

3. Client Communication & Coordination

• Respond to client queries within agreed turnaround times.
  • Maintain clear and professional communication with clients and internal stakeholders.
  • Provide timely updates on verification status and issue resolution.
  • Share End-of-Day (EOD) reports with the Team Leader.

4. Quality & Compliance

• Maintain high accuracy standards in eligibility verification processes.
  • Ensure adherence to HIPAA, ISMS, QMS, and organizational SOPs.
  • Follow client-specific verification guidelines and workflows.
  • Ensure proper documentation and audit readiness.

5. Issue Resolution & Escalation Management

• Identify and analyze verification denials and rejections.
  • Escalate critical issues impacting workflow or client deliverables.
  • Collaborate with internal teams to resolve discrepancies efficiently.

6. Reporting & Performance Tracking

• Update and track daily KPI metrics and productivity reports.
  • Share verification status and performance updates with stakeholders.
  • Analyze trends in denials and rejections for process improvement.
  • Support KPI tracking and performance evaluations.

7. Team Collaboration & Process Improvement

• Participate in team discussions and knowledge-sharing sessions.
  • Provide backup support during resource unavailability.
  • Identify process gaps and contribute to continuous improvement initiatives.
  • Adapt to process changes, client requirements, and system updates.

Roles and Responsibilities

• Ensure accurate documentation of all interactions with patients, physicians, and other stakeholders related to eligibility verification.

• Verify patient eligibility for medical services by checking insurance coverage, benefits, and policy details.

• Conduct thorough reviews of patient records to identify potential issues or discrepancies in eligibility status.

• Collaborate with healthcare providers to resolve any billing or claims-related issues that may impact patient care.

• Maintain up-to-date knowledge of changing regulations, policies, and procedures governing US healthcare reimbursememt.

• Intrested candiadtes , please share your CV's to the following email ID [email protected] alternately you may also share or connect with Purushothuman @ 8939557733