Eligibility and Risk Specialist

Job Responsibilities

• Verify eligibility and risk delegation for health plan members and maintain customer records.
• Complete eligibility verification requests in a timely manner.
• Research and address problems related to claim rejections and denials.
• Inform management about changes or trends in eligibility and risk issues.
• Adjudicate claims issues by preparing and submitting corrected claims or appeals.
• Recommend claims for write-off when billing requirements are not met.
• Communicate effectively by phone, email, and in-person with third-party payers and internal staff to resolve eligibility issues and build positive relationships.
• Accurately update and annotate accounts receivable system, collections notepad, and customer accounts.
• Stay updated on company policies and procedures and third-party payer guidelines, bulletins, and billing requirements.
• Ensure appropriate follow-up and timely completion of assignments.

Qualifications

• Familiarity with various medical insurance payer guidelines/billing requirements preferred.
• Proficiency in Microsoft Office with experience working in Microsoft Excel.
• Detail-oriented, thorough, accurate, and organized.
• Proven ability to research and solve problems.
• Good written and verbal communication skills.

Pay & Benefits

• $19-20 / hour
• Medical, Dental, and Vision
• 401(k) with Company Match
• Sick and Vacation Days
• Flexible Spending Account
• Life & Disability Insurance
• Education Assistance
• Employee Referral Program
• Career-minded individuals will find our business challenging and our reputation for excellence just one of the rewards we have to offer.