Eligibility and Benefits Verification (RCM)

## Eligibility and Benefits Verification (RCM) ### Role Overview Scope Business Solutions is seeking a detail-oriented and experienced Eligibility and Benefits Verification Specialist to join their Revenue Cycle Management (RCM) team in Hyderabad. The ideal candidate will be responsible for verifying patient insurance eligibility and benefits prior to medical services, ensuring accurate and timely processing to support smooth revenue cycle operations for healthcare clients. ### Key Responsibilities - Verify patient insurance eligibility and benefits through payer portals, phone calls, and electronic systems prior to appointments or services - Review and interpret insurance plan details including co-pays, deductibles, co-insurance, and coverage limitations - Coordinate with medical billing and coding teams to ensure accurate claim submission - Identify and resolve eligibility-related discrepancies and denials in a timely manner - Maintain up-to-date knowledge of payer-specific eligibility verification requirements and guidelines - Document verified eligibility information accurately in the practice management or billing system - Communicate eligibility and benefits findings to relevant internal teams and clients - Follow up on pending or unclear eligibility responses to minimize claim delays - Assist in reducing claim denials by ensuring pre-authorization and eligibility checks are completed prior to service ### Requirements / Qualifications - Prior experience in eligibility and benefits verification within a healthcare RCM environment - Strong understanding of US healthcare insurance plans including commercial, Medicare, and Medicaid - Familiarity with payer portals and electronic eligibility verification tools - Knowledge of medical terminology, CPT codes, and ICD codes is an advantage - Proficiency in practice management and billing software - Excellent attention to detail and strong analytical skills - Good verbal and written communication skills in English - Ability to work in a fast-paced environment and manage multiple tasks efficiently - Experience with denial management and prior authorization processes is preferred ### About the Company Scope Business Solutions is a healthcare business process outsourcing company specializing in Revenue Cycle Management services for US-based healthcare providers. The company focuses on delivering end-to-end RCM solutions including eligibility verification, medical billing, coding, and denial management to optimize the financial performance of its clients. .