Healthcare Customer Service Representative

About the role

EDGE is seeking a Healthcare Customer Service Representative to support US‑based clinics and healthcare practices. The role acts as a liaison between patients, providers, and insurers, ensuring smooth scheduling, eligibility checks, and prior authorizations.

Key responsibilities

• Conduct eligibility checks and verify patient benefits before appointments.
• Interpret insurance policies (PPO, HMO, Medicare/Medicaid) and document patient financial responsibilities.
• Prepare and submit prior authorization requests via portals, fax, or phone.
• Review clinical documentation to confirm medical necessity before submission.
• Track pending authorizations, manage appeals, and expedite urgent requests.
• Handle inbound and outbound calls for scheduling, rescheduling, and appointment reminders.

Required profile

• Minimum 1 year of direct experience in US healthcare scheduling, eligibility verification, or prior authorizations.
• Deep understanding of US insurance concepts such as PPO, HMO, EOBs, copays, and patient benefits.
• Exceptional attention to detail and strong analytical abilities.
• Excellent written and verbal English communication skills.
• Ability to work independently in a fast‑paced environment.

Required skills

• Proficiency with insurance portals (e.g., Availity, Optum, CoverMyMeds).
• Experience using electronic health record or practice management systems (e.g., ECW, Tebra, Dentrix).