Eligibility and Benefits Verification Specialist

This is a fully remote position, open to applicants in Philippines.

📋 Description

• Validate patient eligibility and active coverage for upcoming appointments through payer portals, Availity, and payer telephone lines.

• Confirm behavioral health benefits such as copay, coinsurance, deductible, out-of-pocket status, visit limits, and telehealth coverage.

• Identify behavioral health carve-outs and verify the appropriate payer and claims-submission payer ID.

• Determine if prior authorization is needed for scheduled services and document the requirement and its status.

• Verify primary and secondary coverage, along with coordination of benefits.

• Record verification results in the practice's EHR using the standard note format, including the date benefits were quoted.

• Report coverage issues to the practice contact with a clear request for decision prior to the visit.

• Complete designated daily verification queues within the practice's turnaround times.

• Safeguard patient information and adhere to HIPAA regulations.

⛳️ Requirements

• Minimum of 1 year of experience in U.S. healthcare insurance.

• Practical experience with eligibility and benefits verification.

• Understanding of commercial insurance and government health plans, including Medicare and Medicaid.

• Experience utilizing payer portals and insurance websites.

• Strong proficiency in written and spoken English.

• Exceptional attention to detail and follow-up capabilities.

• Ability to work autonomously while managing multiple patient accounts.

• Stable internet connection and an appropriate remote workspace.

• Availability during Central Time business hours is required.

• Preferred: Background in supporting behavioral health, psychiatry, or mental health counseling practices.

• Preferred: Familiarity with PracticeQ (IntakeQ).

• Preferred: Knowledge of Wisconsin insurance plans, including Wisconsin Medicaid and BadgerCare Plus.

• Preferred: Experience in verifying behavioral health carve-outs, visit limits, and telehealth benefits.

🏝️ Benefits

• Remote position.

• Full-time employment.

• Remote work arrangement.

• Preference for applicants based in the Philippines.