Insurance Verification and Claims Management

I run a primary-care / family-medicine office and I’m ready to hand off two time-consuming but critical tasks: confirming patients’ coverage before they arrive and getting every claim paid promptly afterward. Insurance verification • Each afternoon you’ll pull the next day’s schedule from our EHR, call or portal-check every patient, and record eligibility, copay, deductible, and any required authorizations for a mix of Medicare, Medicaid, and commercial carriers (Blue Cross, Aetna, UnitedHealthcare, etc.). • A same-day spreadsheet—or direct update in the chart—lets my front desk know exactly what to collect and what to flag. Claims management • After each visit you’ll scrub, code-check, and submit claims through our clearinghouse (Availity or similar). • Rejections and denials are followed up within 24 hours; secondary claims and appeals are tracked until payment posts. • Each Friday I expect an aging summary and notes on any items over 30 days. Acceptance criteria – 100 % of next-day appointments verified by 5 p.m. local time – ≥ 98 % first-pass claim acceptance rate – Weekly AR report delivered before Monday clinic opens If you’re comfortable navigating both government and commercial payers, can work inside a modern EHR, and communicate clearly about any outliers, this partnership should run smoothly from day one.