Eligibility Specialist

Responsibilities

• Update demographics and/or insurance information based on feedback provided by internal or payor edits, using available resources: face sheets, insurance cards, eligibility results etc.
• Determine the appropriate insurance carrier and billing information from the data contained in the patient’s medical record and use that information to accurately update a patient’s account in the billing system.
• Utilize the Eligibility process/data in Centricity or on the payors’ websites to obtain more accurate information on each patient returned with an edit.
• Request additional insurance company entries in Centricity when necessary.
• Request direction and clarification from supervisor or lead when necessary, in order to assure accurate resolution of edits.
• Identify and work complex edits presented from various sources.
• Identify and report results of user and/or system issues that impact billing quality.
• Maintain understanding of current departmental policies and procedures.
• Promote a team environment that will support the growth of every department member and achievement of all department goals as a result of team work.
• Participate in meetings and educational programs in an effort to improve both individual and team quality and effectiveness.

Requirements

• One year experience in a medical (billing preferably) environment.
• One year experience in a fast-paced production environment.
• One year experience (preferred) verifying eligibility with various insurance carriers.

Qualifications

• High school diploma or equivalent.
• Field of study preferred: Business or healthcare related field.

Benefits

Comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical, dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources.

Visit our website for further information.