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Outsource Eligibility Verification to the Philippines

An important part of the entire revenue cycle management is Insurance Eligibility Verification.

Eligibility Verification refers to the process of reviewing and checking a patient’s insurance plan’s coverage. Aside from reviewing a patient’s insurance plan’s coverage and status, eligibility verification includes regular updating and monitoring of the patient’s basic information and electronic medical records, contacting of the payor, and identifying co-pays and deductibles.

Eligibility insurance verification is important in ensuring timely & correct payment posting, timely payments, increasing the number of clean claims and reducing billing errors, non-payments and denials.

Roughly 25% of all U.S. hospital spending consists of administrative costs.(Commonwealthfund)

Healthcare providers can increase efficiency and productivity by partnering with outsourcing providers that offer Healthcare outsourcing services.

Outsourcing Eligibility Verification can help improve claim payment accuracy and maintain a low backlog of work by properly identifying pricing and/or submission inconsistencies to management.

Outsourced Eligibility Verification staff can be assigned administrative tasks to improve operations and lower costs such as waiting for an answer to an eligibility question.

Accurate data entry is provided by outsourced eligibility verification specialists. They provide effective and accurate patient record transcription, verify data entered from the claim form is accurate and complete to enable the claim to be processed correctly and accurately.

Eligibility verification specialists contact insurance providers to verify if a patient’s insurance coverage is eligible and active. They verify that the data entered from the claim form is accurate and complete to enable the claim to be processed correctly by insurance payers. They make follow-up telephone calls to maintain accurate records and ensure that medical record account entries are up to date.

Connext Global Solutions is a global business process outsourcing provider based in the Philippines that builds, hires, trains, and manages offshore teams for your business. Clients can build a customized, 100% dedicated offshore team.

Other Sample Healthcare Roles you can outsource:

Medical Billing Specialist

Outsourced Medical Billing Specialists can be primarily tasked to reach out to respective insurance companies via inbound and outbound calling for collecting A/R claims, conduct claim audits, conduct patient calls and follow up on claims for Accounts Receivable, provide accounts creation and accurate data entry, update and maintain claims database, collaborate with other departments to process patient requests.

Other functions of an Outsourced Medical Billing Specialis are:

  • Accessing Database of Payments for posting
  • Payment posting
  • Check posted payments
  • Input A/R payment
  • Claims processing

The tasks can also extend to participate in all quality assessment activities and assist to collect and analyze all information and recommend required improvements to all processes.

Medical Credentialing Specialist

Medical Credentialing Specialists can assist with the overall credentialing and contracting process.

They verify all required and pertinent credentialing information and re-credentialing documentation and assist with group and provider data entry into credentialing software.

Credentialing Specialists complete and submit applications for providers to be credentialed and contracted with payors. They contact payors via phone and/or email to follow-up on applications to ensure timely completion of claims.

Also, they maintain and monitor all licenses and certifications in the database to ensure compliance within all market.

Pre-Authorization Specialist

Prior approvals, called on insurance verification or pre-authorization, is an important role in the revenue cycle management cycle. 

Businesses can outsource the Pre-authorization process.

Outsourced staff conduct can be assigned functions such as submitting and following-up preauthorization to various insurance companies.

They conduct authorization checks such as whether authorization started online by accessing the

database and conduct verification via phone, fax Clinicals/HPI,  Physician peer-to-peer and determine and request any further documents are necessary.

Payment and Cash Posting Specialist

Outsourced Healthcare Support staff can provide payment posting services such as:

  • Posting for all Credit cards/Checks and cash payments
  • Payment postings for insurance payments
  • Payment postings for Central Pay
  • AR Spreadsheet month end closing

Medical Claims Appeals Staff

The Medical Billing process involves researching and resolving pre-processing errors and edits to ensure that claims are filed timely. Accurate and timely processing of claim appeals means compliance with the various payor requirements.

Offshoring claims processing services can help improve claim payment accuracy. The outsourced staff verifies data entered from the claim form is accurate and complete to enable the claim to be processed correctly.

Outsourced Medical Claims Appeals staff can be offloaded claims appeals services such as correcting denied claims, sending corrected claims and managing denials. These Medical Claims Appeals staff are in charge of checking claim statuses online, correcting denied claims, resolving discrepancies and processing refund requests or settlements, and sending corrected claims.

Patient Scheduler

The time and effort spent by front desk/in-house Healthcare staff on administrative tasks such as waiting for an answer to an eligibility question or for a pre-authorization, can be delegated to a dedicated Offshore Healthcare team.

Outsourced healthcare support staff can be offloaded administrative tasks such as patient scheduling. Healthcare support staff act as the dedicated resource to help businesses set up appointments via phone, email, social media etc. These support staff are skilled in scheduling (e.g. Google Calendar), communications, and other related clerical and documentation tasks. 

Outsource to Connext today.

Gain a broader perspective on healthcare innovation by exploring our blog post about the role of blockchain in healthcare, complementing your strategy to outsource eligibility verification to the Philippines.