Medical Eligibility & Verification (EV) Specialist
Location : Ahmedabad
Shift : Night Shift (US Process)
Job Type : On-site / Hybrid
Job Summary :
We are looking for a detail-oriented Medical Eligibility & Verification Specialist to handle insurance verification for US-based healthcare clients. The role involves verifying patient eligibility, insurance benefits, and prior authorizations to ensure accurate and timely claim processing.
Key Responsibilities :
- Verify patients' insurance coverage, eligibility, and benefits before appointments or procedures.
- Confirm active policies and coverage details directly with insurance carriers (via calls or portals).
- Obtain prior authorizations or pre-certifications as required.
- Accurately document verification details in the billing system.
- Communicate with providers and patients regarding coverage limitations or missing information.
- Coordinate with billing and coding teams to resolve any coverage-related issues.
- Maintain confidentiality and adhere to HIPAA compliance standards.
Required Skills & Qualifications :
Minimum 1–3 years of experience in Medical Eligibility & Verification / RCM process.Strong understanding of US healthcare insurance terminology and payer rules.Proficiency in working with payer portals and healthcare billing systems.Excellent verbal and written communication skills (English).Attention to detail and ability to multitask in a fast-paced environment.Knowledge of Medicare, Medicaid, PPO, HMO plans preferred.Educational Qualification :
Graduate in any discipline (Preferred : Healthcare, Life Sciences, or related field).Job Type : Full-time
Pay : ₹10, ₹30,000.00 per month
Work Location : In person