Description
This unit equips learners with the skills to verify insurance eligibility accurately and efficiently—a foundational step in achieving clean claim submission. Learners explore real-time eligibility systems, required payer data fields, and transaction report analysis for determining coverage and pre-authorization requirements.
The course integrates both theoretical understanding and hands-on platform navigation to help students prevent costly eligibility denials, streamline front-end workflows, and enhance overall revenue cycle performance.
Explain the role of real-time eligibility verification.
Identify key data fields—such as member ID, group number, date of birth, and plan type—required for validating insurance.
Demonstrate the correct use of eligibility verification platforms (e.g., Availity, Experian, EHR-integrated systems).
Analyze payer response reports and eligibility transaction summaries to determine patient coverage status and pre-authorization requirements.
Evaluate the impact of eligibility errors on claim outcomes, denial trends, and revenue cycle performance.
Create a step-by-step job aid or checklist for performing accurate and compliant eligibility verification.
Upon completion, learners will be able to:
Accurately capture and verify patient insurance details in real-time systems.
Navigate payer verification tools and interpret response codes effectively.
Recognize and correct common data entry and eligibility matching errors.
Analyze eligibility reports to determine coverage status and identify pre-certification needs.
Develop a compliant eligibility verification checklist or job aid.
Apply payer-specific verification rules to prevent downstream denials and billing delays.
Completion of Unit 2.1 (Front-End Services and Patient Intake) or equivalent foundational knowledge.
Basic familiarity with payer terminology, EHR interfaces, or registration workflows.
Follow Coral Plus LMS policies: participation, integrity, respectful conduct, HIPAA/privacy adherence, timely completion of assessments. 1. Participants should register in advance to receive access details. 2. Access links and passwords, if applicable, should be provided securely to registered participants. 3. Participants are encouraged to join the webinar a few minutes early to resolve any technical issues 4. Participants are responsible for ensuring a stable internet connection, compatible devices (computer, tablet, or smartphone), and recommended browsers. 5. A microphone and webcam may be required for interactive sessions. Please test your audio and video settings in advance. 6. The webinar may be recorded for educational purposes. 7. Recorded sessions may be shared with registered participants after the webinar. 8. Please be mindful not to share personal or confidential information during the webinar. 9. A detailed agenda will be provided, and each session will adhere to the schedule to cover all planned topics. 10. Time will be allocated for Q&A sessions and discussions. 11. A helpdesk or contact information for technical support will be provided during the webinar. 12. Common technical issues will be addressed at the beginning of the session. 13. Relevant resources, such as presentation slides or additional reading materials, will be shared after the webinar.
Patient Access and Eligibility Verification Specialists
Billing and Pre-Authorization Coordinators
RCM Analysts and Front-End Team Leads
Medical Office Administrators and EHR Staff
Healthcare Management Students pursuing RCM certification
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