Insurance Authorization and Eligibility Specialist
Job summary
The Insurance Authorization and Eligibility Specialist is responsible for verifying patient insurance coverage, ensuring necessary procedures are covered by an individual’s provider, and navigating patient insurance information to secure proper authorization for healthcare services.This role requires a strong understanding of various insurance plan
Min. qualification
Bachelors
Experience level
Mid level
Experience length
2 years
Language
English
Working hours
Full Time - Afternoon Shift
Applicant location
Nairobi, Kenya
Job description & requirements
Job Description
Key Responsibilities:
- Insurance Verification: Confirm insurance coverage for services and procedures as per the individual’s specific healthcare plan.
- Authorization Acquisition: Obtain necessary pre-authorizations or referrals prior to patient appointments and procedures.
- Eligibility Checks: Conduct regular eligibility checks to ensure patients’ insurance coverage remains valid and up to date.
- Communication: Act as a liaison between patients, healthcare providers, and insurance companies to convey insurance decisions and discuss alternative solutions if coverage is inadequate.
- Documentation: Maintain detailed and accurate records of all interactions, authorizations, and correspondence with insurance providers.
- Compliance: Ensure compliance with all federal and state regulations regarding medical insurance and patient confidentiality.
- Patient Assistance: Educate patients about their insurance benefits and responsibilities.
Required Qualifications:
- Education: Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field.
- Experience: Minimum of 2 years in insurance verification, medical billing, or a related field within a healthcare setting.
- Skills: Proficiency in medical software systems, understanding of medical billing procedures and regulations, and strong organizational and communication skills.
Desired Characteristics:
- Strong attention to detail and ability to multitask effectively.
- Excellent problem-solving skills and the ability to think analytically.
- Compassionate and professional demeanor with a patient-centric approach.
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