Eligibility Verification - Senior Process Analyst

Summary:

The Senior Back-End Registration Verification and Eligibility Specialist is responsible for ensuring the accuracy and completeness of patient registration data and verifying insurance eligibility after the patient encounter. This role focuses on resolving registration errors, investigating eligibility discrepancies, and working with payers to obtain accurate coverage information. The Senior Specialist handles complex cases, provides guidance to junior team members, and plays a key role in minimizing billing errors and maximizing reimbursement.

Key Responsibilities:

Registration Verification:

•Review patient registration data for accuracy and completeness, including demographics, insurance information, and guarantor details.

•Identify and correct errors in registration data, working with internal departments to obtain accurate information.

•Research and resolve registration-related claim denials.

•Maintain accurate and up-to-date patient records in the registration system.

•Work with front-end registration staff to improve data capture processes.

Insurance Eligibility Verification:

•Verify insurance eligibility using online portals, phone calls, and other methods after the patient has received services.

•Investigate and resolve eligibility discrepancies, such as incorrect insurance information or coverage gaps.

•Obtain accurate insurance coverage information from payers, including copays, deductibles, and coinsurance.

•Document all eligibility verification activities accurately and thoroughly in the billing system.

•Identify and resolve eligibility-related claim denials.

Payer Compliance:

•Stay current on payer-specific eligibility verification requirements.

•Ensure compliance with all applicable regulations and guidelines.

•Research and resolve payer-specific eligibility issues.

Data Analysis and Reporting:

•Prepare reports on registration and eligibility verification metrics, such as error rates and denial rates.

•Analyze data to identify trends and patterns in registration and eligibility issues.

•Recommend process improvements based on data analysis.

Team Leadership and Mentorship:

•Serve as a mentor and resource for junior Registration Verification and Eligibility Specialists.

•Provide guidance and support to the team on complex cases and eligibility challenges.

•Assist in training new team members on registration verification and eligibility procedures.

System Proficiency:

•Utilize registration systems, eligibility verification tools, and payer portals to perform job duties.

•Maintain accurate and up-to-date information in all systems.

Liaison Activities:

•Communicate with clinical and revenue cycle teams to resolve issues and facilitate accurate claim submission.

Qualifications, Experience & Skills:

•Undergraduate degree or equivalent required; Bachelor's degree in a related field preferred

•Minimum of 3-5 years of experience in patient registration, insurance eligibility verification, or related healthcare field.

•Strong knowledge of medical billing and insurance concepts.

•In-depth knowledge of insurance eligibility verification processes.

•Excellent communication and interpersonal skills.

•Strong analytical and problem-solving abilities.

•Proficiency in using registration systems, eligibility verification tools, and payer portals.

•Ability to work independently and as part of a team.

Excellent organizational and time-management skills