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Company Description
Gulf Coast RCM and Billing Solutions is a fast-growing startup dedicated to becoming a leader in high-performance Revenue Cycle Management (RCM) and clinical solutions. We specialize in building elite remote teams for medical practices across the US, focusing on Scribing, Coding, Billing, and Front-Office operations. Our mission prioritizes Clients, our People, and Operational Excellence to add value to the healthcare ecosystem. By selecting only the top 1% of industry professionals and fostering an environment for peak performance, we ensure a high-security infrastructure with cutting-edge technology and a professional corporate culture.
Role Description
This is a full-time, on-site role for an Eligibility & Benefits Verification Specialist based in Hyderabad. The role involves verifying patients’ insurance eligibility and benefits, interacting with insurance companies for accurate information, and ensuring compliance with billing procedures. Additional responsibilities include supporting patient and provider inquiries regarding insurance plans and maintaining precise documentation in alignment with healthcare regulations.
Key Responsibilities- Insurance Verification & Portals: Connect directly with various US commercial and government payers via outbound calling and web portals (e.g., Availity, Navinet, and payer-specific sites) to verify real-time patient eligibility and detailed active benefits.
- Data Capture & Cost-Sharing: Accurately extract and document granular policy details including plan types (HMO, PPO, HDHP), policy active dates, patient cost-sharing information (deductibles, co-pays, co-insurance), and out-of-pocket maximums.
- Prior Authorization Management: Identify specific insurance pre-certification and prior authorization requirements for upcoming medical visits, diagnostics, or procedures, and actively coordinate with payers to obtain necessary approvals.
- Workflow Prioritization: Efficiently manage and prioritize daily inventory volume based on appointment schedules to ensure all patient accounts are fully verified well ahead of the date of service.
Required Qualifications & Skills- Experience: 2–5 years of core experience in US Healthcare Reimbursement, specifically handling Front-End RCM (Eligibility Verification and Prior Authorizations).
- Payer Knowledge: Strong working knowledge of US insurance networks, payer guidelines (Medicare, Medicaid, BCBS, UnitedHealthcare, Aetna, Cigna), and the authorization process.
- Communication Skills: Excellent verbal communication and neutral accent for clear professional interactions with US insurance representatives over the phone.
- Technical Savvy: Experience working with major EHR/Practice Management systems (e.g., AthenaOne, eClinicalWorks, Epic) and clearinghouses.
- Operational Discipline: Proven capability to work under tight daily deadlines, manage volume spikes, and maintain high data entry accuracy.
- Experience obtaining prior authorizations for specialized GI procedures (e.g., Colonoscopies, Endoscopies) or specialty medications/biologics is highly preferred.
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