Roles & Responsibilities:

Eligibility Verification:

• Verify patient eligibility and benefits through payer portals and insurance calls
• Work on eligibility-related denials and exceptions
• Handle eligibility faxes and paper claims
• Review and resolve eligibility bucket scenarios
• Identify and resolve insurance-related issues impacting claims
• Ensure accurate insurance information to avoid future denials
• Maintain and update process documents/SOPs when required

Payment Posting:

• Perform ERA and EOB payment posting activities
• Work on electronic and paper remittances
• Handle payment posting from AR escalations
• Perform manual posting of EOBs received through email/fax
• Reconcile payer portals to ensure all payments are posted accurately
• Identify and report payment discrepancies and enrollment-related issues