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9 jobs that use Insurance Eligibility the most

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Jobs that use insurance eligibility the most include outpatient clerk, admitting interviewer, and medical service representative.

What jobs use Insurance Eligibility the most?

1. Outpatient Clerk

How outpatient clerk uses Insurance Eligibility:

  • Manage confidential patient information according to HIPPA guidelines.
  • File Medicare, follow-up insurance claims, prepare Medicaid logs.
  • Provide proper CPT codes to outside facilities so that prior authorization can be obtain for the correct exams.

Most common skills for outpatient clerk:

  • Patients
  • Schedule Appointments
  • Data Entry
  • Insurance Eligibility
  • Direct Phone Calls
  • Departmental Policies

2. Admitting Interviewer

How admitting interviewer uses Insurance Eligibility:

  • Manage confidential patient information according to HIPPA guidelines.
  • Remain positive in every negative situation, using compassion and personality appropriately to asses and diffuse critical situations.
  • Assign ICD-9 and CPT coding on all admissions.

Most common skills for admitting interviewer:

  • Patients
  • Insurance Eligibility
  • Insurance Verification
  • Customer Service
  • Epic
  • Data Entry

3. Medical Service Representative

How medical service representative uses Insurance Eligibility:

  • Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
  • Review and resolve NCCI and medical necessity edits in compliance with CMS, CPT, ICD-10 and ICD-9 guidelines.
  • Utilize ICD-9-CM and CPT coding principles in the assignment and sequencing of diagnostic and procedure billing codes.

Most common skills for medical service representative:

  • Patients
  • Insurance Eligibility
  • HIPAA
  • Medicaid
  • Medical Terminology
  • Patient Care

4. Medical Billing And Coding Externship

How medical billing and coding externship uses Insurance Eligibility:

  • Manage chart completion (ICD-9-CM and CPT coding/abstracting), chart assembly and analysis, patient admission and patient information privacy/security.
  • Verify correct ICD-10 and CPT codes for a variety of specialties.
  • Review physicians' appointment notes to determine appropriate ICD-9 and HCPCS code for the medical service render.

Most common skills for medical billing and coding externship:

  • Patients
  • Insurance Eligibility
  • Data Entry
  • EOB
  • Insurance Verification
  • CPT-4

5. Insurance Verification Specialist

How insurance verification specialist uses Insurance Eligibility:

  • Check CPT and ICD-10 codes with LCD and policies from multiple insurance companies to make sure procedures will be paid.
  • Support the patient privacy/confidentiality policies and regulations under HIPAA for patients and their medical records.
  • Confirm correct charges base on HCPCS codes.

Most common skills for insurance verification specialist:

  • Patients
  • Insurance Verification
  • Customer Service
  • Insurance Eligibility
  • Data Entry
  • Medical Terminology

6. Senior Patient Service Representative

How senior patient service representative uses Insurance Eligibility:

  • Prioritize and manage multiple tasks; working knowledge of hospital billing systems/ follow-up process and CPT and ICD-9 coding.
  • Manage PSR staff and perform all PSR functions including registration, check-out, medical records, order entry and procedure scheduling.
  • Pursue reimbursement on accounts with general understanding of CPT, HCPCS, ICD-9, drugs, and revenue codes.

Most common skills for senior patient service representative:

  • Patients
  • Patient Service
  • Patient Care
  • Patient Appointments
  • Insurance Eligibility
  • Insurance Verification

7. Authorization Specialist

How authorization specialist uses Insurance Eligibility:

  • Demonstrate knowledge of HIPAA by appropriately managing patient confidentiality.
  • Utilize CMS and InterQual criteria to establish authorizations for members requiring medical services for a Medicare advantage insurance company.
  • Build authorization, match ICD-10 codes with there procedure codes

Most common skills for authorization specialist:

  • Patients
  • Customer Service
  • Insurance Verification
  • Medical Terminology
  • Insurance Eligibility
  • Veterans

8. Insurance Coordinator

How insurance coordinator uses Insurance Eligibility:

  • Verify patient dental insurance coverage and limitations with major private and business dental insurance providers as well as Medicaid and Medicare.
  • File to record patient demographics in numerous EMR systems and paper charts if applicable.
  • Prepare providers and staff for ICD-10 transition.

Most common skills for insurance coordinator:

  • Patients
  • Customer Service
  • Insurance Verification
  • Insurance Eligibility
  • Medicaid
  • Medical Terminology

9. Dispensing Optician

How dispensing optician uses Insurance Eligibility:

  • Communicate information and provide customer service to patients, families and visitors.
  • Fax Rx to proper lab.
  • Scan documents and abide by all HIPAA regulations.

Most common skills for dispensing optician:

  • Patients
  • Patient Care
  • Customer Service
  • Insurance Eligibility
  • Appointment Scheduling
  • Eye Exams

Other skills

Updated December 28, 2023