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I will do eligibility verification, claims support, and prior authorization
Medical Billing Professional Eligibility Claims and Authorizations
Hello! I am a Medical Billing and RCM Specialist with experience in Advanced Eligibility and Benefits Verification, Prior Authorization submissions, and ESRD-related medical claims. I am proficient in...
About this Gig
Welcome to my gig!
I am a Medical Billing and Revenue Cycle Management (RCM) professional with 2.5+ years of experience in Advanced Eligibility and Benefits Verification, Prior Authorization Submission, and Medical Claims Support. I have hands-on experience with ESRD-related claims and help healthcare providers improve reimbursement through accurate insurance verification and authorization processing.
My services include verifying active coverage, plan benefits, deductibles, copays, coinsurance, out-of-pocket maximums, referral requirements, authorization requirements, network status, and service-specific benefits.
I have experience working with Commercial Insurance Plans, Medicare, Medicaid, and ACA Exchange Marketplace Plans. I am proficient in using Availity, Experian, NaviNet, and Palmetto GBA for eligibility verification, benefits review, claim status checks, and authorization-related tasks.
I submit prior authorizations through payer portals, fax, and phone calls while ensuring proper documentation and timely follow-up. I provide accurate and reliable RCM support to help healthcare providers reduce denials, improve reimbursement, and streamline revenue cycle operations.
Purpose:
Business
FAQ
What information do you need to verify insurance eligibility and benefits?
I will need the patient's demographics, insurance details (Member ID, DOB), provider information, and the specific services/procedures that need verification.
What details are included in the Eligibility & Benefits Verification report?
The report includes active coverage status, in-network/out-of-network status, copay, coinsurance, deductible, out-of-pocket maximum, authorization requirements, referral requirements, and coverage limitations.
Do you provide Prior Authorization services?
Yes. I can submit prior authorization requests, follow up with insurance companies, and provide status updates until a determination is received.
Can you work with all insurance payers?
Yes. I have experience working with commercial insurance plans, Medicare, Medicaid, and managed care organizations through payer portals and direct calls.
How do you handle claim denials?
I review denial reasons, identify root causes, provide recommendations for correction, and assist with resubmission or appeals when required.
Is patient information kept confidential?
Absolutely. All information is handled professionally and confidentially following HIPAA compliance standards.
What is your turnaround time?
Most eligibility verifications and authorization requests are completed within 24 hours, depending on payer response times and case complexity.
Do you work with individual providers and medical practices?
Yes. I support physicians, clinics, medical practices, billing companies, and healthcare organizations.
Why should I choose your service?
I have 2.5+ years of Medical Billing and Revenue Cycle Management experience, specializing in Eligibility & Benefits Verification, Prior Authorization, and Claims Support with a focus on accuracy and timely delivery.
