Registration/Eligibility Edits Specialist

Overview

The Registration/Eligibility Edits Specialist plays a vital role in ensuring the accuracy and completeness of patient demographic information necessary for medical billing and claims processing. This position helps minimize billing inaccuracies and supports prompt reimbursement by verifying insurance details, correcting inconsistencies, and keeping patient records current.

Key Responsibilities

• Review and validate patient demographic data such as name, birth date, address, and contact details within billing systems to ensure correct information.
• Confirm insurance coverage and eligibility by accessing payer portals or clearinghouses, updating patient insurance records as required.
• Ensure compliance with HIPAA regulations by maintaining the confidentiality of sensitive data and accurately documenting all data corrections and verifications for audit readiness.

Qualifications

• Possess a High School Diploma or equivalent educational qualification.
• Have 1 to 2 years of experience in areas such as medical billing, patient registration, insurance verification, or comparable healthcare administrative roles.
• Understand insurance plans, billing procedures, and HIPAA standards.
• Experience working with Electronic Health Records (EHR) and billing platforms like Epic, Cerner, or Athena is beneficial.