Medical Insurance Eligibility Specialist

Job Description The Cardiovascular Care Group Position Summary The Cardiovascular Care Group is seeking a detail-oriented and customer-focused Insurance Eligibility Specialist to join our growing team. This position is responsible for verifying patient insurance coverage, benefits, referrals, and authorization requirements prior to services being rendered. The Insurance Eligibility Specialist works closely with patients, providers, insurance carriers, and internal departments to ensure accurate benefit verification, minimize claim denials, and support a seamless patient experience. The ideal candidate will possess strong knowledge of medical insurance plans, excellent communication skills, and the ability to manage multiple priorities in a fast-paced healthcare environment. Essential Duties and Responsibilities: Insurance Verification & Eligibility Verify patient insurance coverage, eligibility, and benefits for scheduled appointments, diagnostic testing, procedures, and office visits. Confirm policy information, deductibles, copayments, coinsurance, out-of-pocket obligations, and coverage limitations. Review insurance requirements for specialty cardiovascular services and procedures. Update and maintain accurate insurance information within the electronic medical record (EMR) and practice management systems. Identify and resolve insurance discrepancies prior to patient appointments. Authorization & Referral Management Determine authorization and referral requirements based on payer guidelines. Obtain, track, and document required referrals and prior authorizations. Coordinate with referring physicians, insurance carriers, and clinical staff to ensure timely approvals. Monitor authorization status and promptly address authorization-related issues. Patient Financial Communication Educate patients regarding insurance coverage and estimated financial responsibility. Communicate copayment, deductible, and coinsurance obligations before services are provided. Assist patients with questions regarding insurance benefits and coverage. Provide exceptional customer service while maintaining patient confidentiality. Revenue Cycle Support Collaborate with scheduling, clinical, billing, and collections teams to ensure accurate and complete patient information. Assist in preventing claim denials by ensuring eligibility and authorization requirements are met. Review work queues and reports to identify accounts requiring follow-up. Support departmental initiatives focused on improving revenue cycle performance and patient satisfaction. Compliance & Documentation Maintain compliance with HIPAA and all applicable healthcare regulations. Accurately document verification activities, authorization numbers, and payer communications. Follow organizational policies, procedures, and quality standards. Participate in audits and process improvement initiatives as needed. Qualifications: Education High School Diploma or GED required. Associate degree in Healthcare Administration, Business, or related field preferred. Experience Minimum of 2 years of experience in medical insurance verification, patient access, registration, or revenue cycle operations required. Experience working in a physician practice, specialty practice, hospital, or healthcare setting preferred. Cardiovascular or specialty care experience preferred. Experience verifying commercial, Medicare, Medicaid, and managed care plans. Knowledge, Skills & Abilities Strong understanding of medical insurance plans and payer requirements. Knowledge of insurance eligibility verification, referrals, and prior authorizations. Familiarity with healthcare terminology and medical office operations. Proficiency with EMR and practice management systems. Strong organizational and multitasking skills. Excellent attention to detail and accuracy. Effective verbal and written communication skills. Ability to work independently and collaboratively in a team environment. Commitment to delivering outstanding patient service. Preferred Qualifications Knowledge of cardiovascular procedures and d #J-18808-Ljbffr 6AM City, LLC