Job Title: Eligibility & Verification Specialist

Department: Revenue Cycle Management (RCM)

Reports To: EV Team Lead / Manager

Job Summary

The Eligibility & Verification Specialist is responsible for verifying patient insurance eligibility, benefits, and coverage details prior to services being rendered. The role ensures accurate and timely validation of insurance to minimize claim denials and improve cash flow.

Key Responsibilities

• Verify patient insurance eligibility and benefits using payer portals, clearinghouses, or direct payer communication.
• Confirm coverage details such as active dates, co-pays, deductibles, co-insurance, out-of-pocket, and plan limitations.
• Accurately update insurance and eligibility information in the practice management system/EHR.
• Communicate benefit details and financial responsibility to front office staff or billing teams.
• Track, escalate, and resolve discrepancies related to coverage or insurance denials.
• Maintain productivity and quality benchmarks (accuracy, turnaround time, and call handling if applicable).
• Document all verification steps and outcomes in line with compliance and organizational guidelines.
• Support cross-functional teams (coding, billing, AR follow-up) in resolving eligibility-related claim denials.
• Stay updated on payer policies, eligibility processes, and compliance requirements (HIPAA).

Skills & Competencies

• Strong knowledge of insurance eligibility & benefits verification
• Familiarity with commercial payers, Medicare, Medicaid, and managed care plans.
• Proficiency in payer portals, clearinghouse tools, and EHR/Practice Management systems.
• Excellent communication skills (written and verbal).
• Strong attention to detail, accuracy, and analytical skills.
• Ability to work in a fast-paced environment and meet deadlines.
• Team-oriented with problem-solving mindset.

Performance Metrics (KPIs)

• Accuracy % in verification.
• Turnaround Time (TAT) adherence.
• Productivity (accounts verified per day).
• Reduction in eligibility-related denials.
• Compliance with HIPAA and organizational standards.

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Job Overview:

The Same Day Surgery (SDS) Coder is responsible for reviewing, analyzing, and assigning accurate ICD-10-CM, CPT, and HCPCS Level II codes for diagnoses, procedures, and services performed in a same day/outpatient surgical setting. The coder ensures compliance with official coding guidelines, payer-specific regulations, and organizational standards to optimize reimbursement and maintain data integrity.

Key Responsibilities

• Review operative reports, physician documentation, and medical records for same day surgery cases.
• Assign accurate ICD-10-CM diagnosis codes and CPT/HCPCS procedure codes with appropriate modifiers.
• Ensure coding compliance with AAPC, AHIMA, CMS, and payer-specific regulations.
• Query providers when clarification is needed for documentation completeness or accuracy.
• Validate medical necessity and correct coding to support insurance reimbursement.
• Collaborate with billing, compliance, and revenue integrity teams to resolve denials and coding-related issues.
• Maintain knowledge of current coding guidelines, medical terminology, anatomy & physiology, and surgical procedures.
• Meet productivity and quality standards as defined by the department.
• Participate in continuing education and training to stay current with regulatory and coding changes.

Qualifications

• Education: High school diploma or equivalent (required)
• Certification: CPC, COC, or CCS credential (required).
• Experience: Minimum 2 years of outpatient or same day surgery coding experience (orthopedic, gastrointestinal, ophthalmology, general surgery preferred).
• Strong knowledge of ICD-10-CM, CPT, HCPCS, and modifiers.
• Familiarity with EHR and coding/billing systems (e-Clinical Works)
• Excellent attention to detail, analytical skills, and ability to work independently.

Please send your resumes to careers@hcintellect.com or click below to apply
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Job Summary

We are seeking a results-driven and detail-oriented Quality Leader / Supervisor to lead and execute comprehensive audit functions, error trend analysis, retrospective audits, root cause analysis (RCA), and quality improvement initiatives. This role plays a critical part in enhancing overall coding accuracy, developing focus-area training, and maintaining audit excellence across the team.

Key Responsibilities

Audit Planning & Execution

• Develop and implement structured audit schedules tailored to coding risk areas and service lines.
• Oversee the execution of internal audits ensuring accuracy, completeness, and timeliness of deliverables.

Error Trend Analysis & RCA

• Monitor and evaluate audit results to identify error trends and compliance risks.
• Conduct detailed root cause analysis (RCA) to assess contributing factors and define corrective actions.

Retrospective Audit Management

• Lead retrospective audits for high-impact claims and clinical documentation reviews.
• Track post-bill audit outcomes to drive quality improvements.

QIP (Quality Improvement Program) Execution

• Support the planning, execution, and evaluation of Quality Improvement Programs aligned with audit outcomes.
• Document and report performance metrics, coding quality scores, and progress of QIP initiatives.

Focused Team Training & Development

• Coordinate and deliver regular training sessions based on recent audit trends and RCA findings.
• Design and execute targeted refresher training modules for coders and auditors across specialties.

Required Skills & Qualifications

• AHIMA & AAPC Certified credentials (e.g., CPC, CCS) is required.
• Minimum 5– 7 years of coding/auditing experience with 1–2 years in a Team leader or supervisory or quality-focused role.
• Strong skills in audit planning, RCA, and retrospective audit analysis.
• Excellent understanding of ICD-10-CM, CPT, HCPCS, CMS guidelines, and payer-specific rules.
• Strong analytical mindset with ability to translate findings into action.
• Effective communication, leadership, and training delivery skills.

Preferred Qualifications

• Experience with QIP tracking tools and audit dashboards.
• Prior involvement in RCA initiatives or clinical quality reviews.
• Knowledge of payer audit patterns and post-payment audit defense strategies.

Work Environments

• This is a full-time work-from-office position.
• The candidate must be available to work collaboratively with coding and audit teams in multiple time zones.

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Job Overview

We are seeking a detail-oriented and experienced Spinal and Pain Surgery Coder to join our medical coding team. In this role, you will be responsible for accurately coding medical procedures related to spinal surgery and pain management, ensuring compliance with all relevant healthcare regulations and standards. This is a vital role in ensuring that claims are processed correctly for insurance reimbursement.

Key Responsibilities

• Review clinical documents and patient records to determine the correct codes for spinal surgery and pain management procedures.
• Assign ICD-10, CPT, and HCPCS codes to surgical procedures, diagnostic tests, treatments, and other medical interventions.
• Ensure accuracy in coding to support timely and accurate billing for services rendered in spinal and pain surgery.
• Work with healthcare providers, surgeons, and medical professionals to clarify any discrepancies in documentation and coding.
• Maintain knowledge of coding changes, updates, and revisions, particularly related to spinal and pain procedures.
• Ensure compliance with insurance and regulatory requirements related to spinal surgery and pain management procedures.
• Conduct coding audits to ensure quality assurance and accurate documentation.
• Prepare reports and track coding productivity and accuracy metrics.
• Stay up-to-date with industry standards, billing practices, and new coding methodologies specific to spinal and pain surgeries.
• Assist in resolving coding-related issues or denials by providing necessary documentation.

Qualifications

• 2+ years of experience in Spine & Pain Coding.
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) credential (preferred).
• Strong knowledge of ICD-10, CPT, and HCPCS coding systems.
• Proven experience coding spinal and pain surgery procedures, preferably in a clinical or hospital setting.
• Familiarity with medical terminology and anatomy related to the spine and pain management.
• Attention to detail and strong organizational skills.
• Ability to work independently and meet deadlines.
• Excellent communication skills for collaborating with clinical teams and resolving discrepancies.
• Familiarity with electronic health records (EHR) and coding software.

Preferred Skills

• Prior experience coding for orthopedic surgeries or pain management procedures.
• Knowledge of insurance payer requirements and regulations specific to spinal surgery claims.

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Roles and Responsibilities

• Addresses Coding Denials by accurate editing and resubmission of erroneously submitted claims.
• Very strong knowledge in understanding the denial codes and categories.
• Focuses on updating coding skills, knowledge, and accuracy by participating in coding team meetings and educational conferences.
• Review and analyze claim denials to perform the appropriate appeals necessary for reimbursement.
• Good medical policy surfing knowledge in reviewing appropriate policy guidelines in line with denials.
• Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials.
• Prepares an analytical summary report identifying areas of concern, volume and new denials.
• Tracks improvement of targeted denials once process or system edits have developed to reduce/prevent future denials.
• Writes reports clearly and concisely, demonstrating the ability to integrate insights, organize materials and address objectives.

Desired Candidate Profile

• 2 + years’ experience in related field or comparable combination of education and experience.
• Should possess coding hands-on experience on E&M and surgery coding (Preferable Chronic Pain management).
• Knowledge of the current healthcare climate, including managed care developments, HIPAA standards and governmental program regulations

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JOB DESCRIPTION

• Perform pre-call analysis and check status by calling the payer or using IVR or web portal services
• Maintain adequate documentation on the client software to send necessary documentation to insurance companies and maintain a clear audit trail for future reference
• Record after-call actions and perform post call analysis for the claim follow-up
• Assess and resolve enquiries, requests and complaints through calling to ensure that customer enquiries are resolved at first point of contact
• Provide accurate product/ service information to customer, research available documentation including authorization, nursing notes, medical documentation on client's systems, interpret explanation of benefits received etc prior to making the call
• Perform analysis of accounts receivable data and understand the reasons for underpayment, days in A/R, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials / underpayments.

JOB REQUIREMENTS

To be considered for this position, applicants need to meet the following qualification criteria

• 1-4 Years experience in accounts receivable follow-up / denial management for US healthcare customers
• Fluent verbal communication abilities / call center expertise
• Knowledge on Denials management and A/R fundamentals will be preferred
• Willingness to work continuously in night shifts
• Basic working knowledge of computers.
• Prior experience of working in a medical billing company and use of medical billing software will be considered an advantage. Access Healthcare will provide training on the client's medical billing software as part of the training.
• Knowledge of Healthcare terminology and ICD/CPT codes will be considered a plus

Benefits

• Two way Cab Facilities Provided
• Attractive Incentive Plan

Please send your resumes to careers@hcintellect.com or click below to apply
Apply now