Eligibility & Benefits Verification Representative

Job Summary:

We are seeking a highly detail-oriented Eligibility & Benefits Verification Representative to join our fast-paced Neurology practice. The ideal candidate will be responsible for verifying patient insurance eligibility, benefits, and copay information; maintaining accurate patient records; and ensuring all documentation within the Electronic Health Record (EHR) system is complete and up to date.

This role plays a critical part in ensuring smooth patient access to care by validating insurance coverage, managing referrals, and supporting accurate patient chart maintenance.

Key Responsibilities:

Insurance Verification

• Verify patient insurance eligibility, benefits, coverage details, and copay responsibilities.
  
• Ensure all insurance information is accurately documented in the EHR system.
  
• Confirm referral effective and termination dates as needed.
  
Patient Chart Management

• Update and maintain patient charts with accurate insurance and referral information.
  
• Flag patient accounts and charts when necessary to ensure proper follow-up.
  
• Enter copay amounts to be collected at the time of service.
  
Referral and Documentation Management

• Review, attach, and manage referrals within patient records.
  
• Ensure all supporting documentation is complete and accurately entered.
  
• Maintain compliance with documentation standards and office policies.
  
Patient Profile Administration

• Create new patient profiles when required.
  
• Identify, merge, and correct duplicate patient records.
  
• Maintain the integrity and accuracy of patient demographic and insurance information.
  
Quality and Compliance

• Safeguard confidential patient information in accordance with HIPAA and company policies.
  
• Perform data verification and quality checks to ensure record accuracy.
  
• Support a positive patient experience through excellent customer service and professionalism.
  

Qualifications:

Required

• College graduate from a medical-related course or healthcare-related field.
  
• Previous experience in Eligibility and Benefits Verification within a healthcare setting.
  
• Working knowledge of insurance verification processes, benefits investigation, and referral management.
  
• Experience using Electronic Health Record (EHR) systems.
  
• Strong attention to detail and organizational skills.
  
• Excellent verbal and written communication skills.
  
• Ability to maintain confidentiality and handle sensitive patient information.
  
• Strong customer service skills and a patient-focused mindset.
  
  
Preferred

• Experience supporting Neurology, Specialty Care, or Physician Practice environments.
  
• Familiarity with medical insurance plans, authorizations, referrals, and copay collection processes.