Eligibility and Verification Specialist

We are seeking a highly organized and detail-oriented Eligibility and Verification Specialist to join our team at a growing Pain Management Clinic. In this role, you will be responsible for verifying patient eligibility for pain management treatments and ensuring all insurance requirements are met. You will work closely with patients, insurance companies, and medical staff to confirm coverage, process insurance authorizations, and maintain accurate records.

Key Responsibilities:
- Insurance Verification: Verify patient insurance eligibility for pain management services, including treatments such as physical therapy, injections, and other pain management therapies.
- Authorization Requests: Coordinate with insurance companies to obtain pre-authorization for pain management treatments and procedures, ensuring compliance with insurance policies and procedures.
- Patient Eligibility: Confirm patient eligibility for specific pain management services by checking insurance details and ensuring treatments align with insurance coverage.
- Document Review: Review and analyze insurance policies and patient documentation (e.g., ID cards, medical records) to ensure accurate verification of benefits and coverage.
- Customer Service: Serve as a point of contact for patients and insurance providers to address questions regarding eligibility, coverage, and authorizations for treatments and services.
- Compliance: Ensure compliance with healthcare regulations, such as HIPAA, and maintain patient confidentiality at all times.
- Data Management: Maintain accurate patient records, input verified insurance information into the clinic’s system, and ensure all documentation is up to date and compliant.
- Reporting: Generate reports regarding insurance verification statuses, authorization requests, and any issues or delays in processing claims.
- Coordination with Medical Team: Collaborate with healthcare providers to ensure that all necessary documentation and authorizations are in place for upcoming treatments.