Eligibility Verification (EV) & Authorization Specialist

Key Responsibilities

Insurance Eligibility & Benefits Verification

• Verify patient insurance eligibility and coverage prior to scheduled services.
• Review active/inactive status, effective dates, termination dates, plan type, and coverage details.
• Verify patient benefits
• Verify benefits for specific CPT/HCPCS and procedure codes when required.
• Identify primary, secondary, and tertiary insurance coverage.
• Confirm coordination of benefits (COB) information when applicable.
• Review payer-specific requirements and benefit limitations.
• Accurately document verification results in the designated system.

Authorization Management

• Obtain authorization from insurance companies through payer portals, phone, fax, or other approved channels.
• Submit authorization requests with accurate patient, provider, diagnosis, and procedure information.
• Track authorization requests from submission through approval, modification, or denial.
• Maintain accurate authorization numbers, approved CPT codes, units, dates of service, and validity periods.
• Identify services that require authorization and communicate requirements promptly to the appropriate internal teams.
• Follow up with payers on pending authorization requests.
• Ensure authorization information is available and accurate before the date of service.