Eligibility Executive

About Us

Yogesher is a healthcare revenue cycle management and medical billing company.

Job Overview

The Billing Executive – Insurance & Eligibility Verification is responsible for verifying patients’ insurance coverage and eligibility before services are provided. This role ensures that all information related to patient insurance is accurate, up-to-date, and compliant with healthcare regulations. The Billing Executive will collaborate with patients, insurance carriers, and internal teams to ensure accurate claims processing, reduce errors, and improve revenue cycle efficiency.

Key Responsibilities

• Insurance Verification:
• Verify patient insurance coverage by contacting insurance companies or utilizing online payer portals.
• Confirm primary and secondary insurance details, including policy number, coverage start and end dates, benefits, and exclusions.
• Ensure all insurance information is accurately documented in the billing system.
• Eligibility Verification:
• Perform eligibility checks by working directly with insurers or using payer-specific online verification systems.
• Validate patient eligibility for services covered under their insurance plan, including any necessary co-pays, deductibles, and co-insurance amounts.
• Resolve discrepancies in eligibility information and escalate issues.
• Claims Support:
• Communicate verified insurance and eligibility details to the billing team for accurate claim submissions.
• Assist in identifying and resolving issues that may prevent accurate claims from being submitted.
• Collaborate with the coding and billing teams to ensure smooth claim generation.
• Documentation & Reporting:
• Document all insurance verification and eligibility activities accurately in the patient’s electronic health record (EHR) and billing system.
• Generate reports on insurance verification results, documenting any denied or unresolved eligibility issues.
• Provide periodic updates to management on the status of insurance verifications and eligibility checks.

Requirements & Tech Stack

• At least 1-2 years of experience in insurance verification, eligibility verification, or billing within the U.S. healthcare system.
• Experience working with various insurance plans, including Medicare, Medicaid, PPO, HMO, and commercial insurance.
• Familiarity with insurance verification software and payer portals.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook) and healthcare billing systems (such as Epic, Cerner, Meditech).
• In-depth knowledge of HIPAA regulations and patient confidentiality guidelines.

Qualifications

• Excellent communication skills.
• Strong attention to detail.
• Ability to work independently, manage multiple priorities, and meet deadlines.