Job Description

Job Duties and Responsibilities:

Patient Outreach & Support

• Contact past patients to obtain updated or missing information needed for claim processing, such as insurance information etc.
• Follow up with patients regarding coordination of benefits (COB) when dual insurance coverage exists.
• Educate patients on required actions with their insurance providers and ensure timely follow-up.
• Document all activities accurately on client platforms
• Handle payer communications through portals and outbound calls
• Flag discrepancies or missing information for client review

Provider Communication

• Reach out to referring physician offices to request or provide needed information such as alternative diagnosis codes accepted by patient payers etc.
• Coordinate with provider offices to ensure claims meet payer requirements
• Handle payer communications through portals and outbound calls
• Flag discrepancies or missing information for client review

Eligibility & Claims Follow-Up

• Perform and support insurance verification, benefits investigation, and eligibility checks
• Perform basic eligibility verification follow-ups with patients to resolve outstanding issues.
• Track and manage claim-related communications to ensure resolution and submission readiness.
• Validate patient eligibility, coverage, and payer requirements in the tools and system (e.g payer portals).
• Review complex cases, escalations, and payer-related issues, then elevate to the client as needed
• Ensure accurate documentation in client systems including EMR and DME platforms
• Ensure alignment with payer guidelines and billing requirements as defined by the client

Systems & Documentation

• Utilize EMR and CRM systems to review patient records and update insurance information as needed.
• Use Microsoft Teams and internal dashboards/portals to manage workflows and communication.
• Maintain accurate, detailed documentation of all interactions and updates.

Required Skills & Qualifications

• Experience in healthcare customer service, medical billing, or claims support is preferred.
• Experience in Members and Provider calls is preferred.
• Experience basic eligibility checks and benefit investigation is an advantage.
• Experience and knowledge on coordination of benefits (COB)
• Strong communication and interpersonal skills.
• High attention to detail and ability to manage multiple follow-ups.
• Familiarity with EMR systems, CRM tools, and Microsoft Teams
• Problem-solving mindset with a focus on timely resolution
• Customer-focused communication.
• Organization and time management skills.
• Analytical thinking for claims and eligibility issues.
• Collaboration across patients, providers, and internal teams

• Handle escalations and ensure timely coordination with the client
• Support client requirements and program needs
• Participate in projects, audits, and business initiatives as required

Job Required Qualification:

• Minimum 3-year solid experience with US Healthcare Insurance
• At least 1 year work experience in a customer service call center (Voice and Back office)
• Strong knowledge on doing Members and provider outreach/calling.
• Familiarity with EMR, DME systems, payer portals, and database entry
• Strong understanding of HIPAA compliance and medical terminology
• Ability to manage high volume workloads and meet performance targets
• Proficiency in MS Word, Excel, and Outlook
• Experience and Exposure with medical Insurance/Benefits investigation and Authorizations.
• High attention to detail and documentation accuracy
• Excellent Customer service skills, including phone and interpersonal skills.
• Typing speed of at least 35 WPM with high accuracy
• Database data entry experience preferred.
• Strong English proficiency, both written and verbal
• Strong attendance, reliability, and accountability
• Ability to work effectively with diverse teams and clients
• High comfort level working with culturally diverse team members and clients.
• Proficient mathematical skills, including addition, subtraction, multiplication, and division.

Preferred Qualifications:

• Startup / rapid growth experience
• Life sciences, pharmaceutical, or medical device experience.
• Knowledge of medical terminology preferred.

Knowledge on DME products (e.g Diabetes Supplies)