“Outsourcing components of our billing services to MedCloud has been a great experience for us. It has enabled us to streamline our operations and raise our bottom line.”

A North East RCM Company

MedCloud RCM Competency : Eligibility/Authorization

To reduce AR delays and claim denials Medcloud crosschecks patient Medical Insurance Eligibility with the applicable Insurance Company which enables us to determine which elements of the treatment is covered by the patient’s policy

Additionally, we initiate and follow through with Preapprovals and Prior Authorizations to work towards collecting quicker payments from payers and a revenue increase.

why choose us

Claim Eligibility
Payment Process

Roles and Responsibilities

Insurance Verification Specialist

The Insurance Verification Specialist’s primary responsibility is reviewing insurance benefits and requirements for patientsby contacting the appropriate insurance company for the purpose of identifying Patient Eligibility,  obtaining Eligibility Term Dates, obtaining deductible information, co-payments and co-insurance amounts due, obtaining Authorization requirements and  subsequently documenting all information in the patient’s account.

  • Obtains Patients’ Medical Insurance Benefits
  • Verifies and obtains any necessary Referral, Pre-Authorization, or Pre-Certification as required by the payer.
  • Ensures accurate, complete, and timely data entry of patients’ Demographic, Financial, and Clinical Information into required system(s).
  • Provides estimates of Patient Self-Pay Responsibility.
  • Maintains regular communication and follow-up with Client Clinical Team, leadership team and  Billing Department regarding Pending Referrals, Authorizations and/or potential issues.
  • Disseminates supporting documentation in a timely manner to Clinicians, Company Leadership, and Billing Department.
  • Completes all documentation, system entry, scanning and filing as required.
  • Cross-trains in various office tasks and supports all office and customer service duties as needed.
  • Maintains a deep understanding of all major insurance plans and products

Want to know more on how Medcloud can help you in reducing costs and inducing operational efficiencies?