Verifier

The Medicare Verifier plays a crucial role in ensuring that patients’ Medicare eligibility, benefits, and coverage details are accurately verified before medical services are rendered. This position helps minimize claim denials by confirming insurance information and financial responsibility, thereby supporting smooth billing and reimbursement processes.

Key Responsibilities:
- Verify Medicare eligibility using payer portals, clearinghouses, and telephone systems.
- Confirm patient details including Medicare number, demographics, effective dates, and coverage status.
- Identify the type of Medicare coverage, such as Original Medicare, Medicare Advantage, Medicare Supplement, or secondary insurance.
- Review patient deductibles, copayments, coinsurance, and benefit limitations to determine financial responsibility.
- Check for prior authorization and referral requirements to ensure compliance with insurance policies.
- Coordinate benefits by identifying primary and secondary payers when applicable.
- Accurately document verification results in electronic medical records or billing systems.
- Communicate any coverage issues or discrepancies to registration, scheduling, billing, and clinical teams.
- Inform patients about their estimated insurance coverage and out-of-pocket financial responsibility.
- Maintain strict HIPAA compliance to protect confidential patient information.
- Assist in resolving claim denials related to eligibility issues to facilitate timely reimbursement.

Required Qualifications:
- Experience with Medicare verification processes and familiarity with payer portals and clearinghouses.
- Strong attention to detail and accuracy in verifying insurance information.
- Ability to interpret Medicare coverage types and benefits, including understanding of deductibles and copayments.
- Proficiency in documenting information within electronic medical records or billing systems.
- Excellent communication skills to effectively liaise with internal teams and patients.
- Knowledge of HIPAA regulations and commitment to maintaining patient confidentiality.
- Problem-solving skills to assist in resolving eligibility-related claim denials.

Compensation and Work Location:
The position offers a monthly salary range of Rs40,000.00 to Rs100,000.00. This role requires in-person attendance at the designated work location.

This role is ideal for candidates who are detail-oriented, knowledgeable about Medicare insurance processes, and committed to supporting accurate billing and patient communication within a healthcare setting.