Eligibility Specialist - REMOTE

Employment Type: Full Time, Remote

About the role

Under direct supervision, you will be responsible for the successful resubmission of invoices to the responsible party. You will analyze and resolve eligibility variances via web research and/or direct contact with patients. Coordinate activities for the acquisition of referrals and retro-authorizations, where applicable. Follow standard procedures and pre-established guidelines to complete tasks. Support and adhere to The US Oncology Compliance Program, including the Code of Ethics and Business Standards, and The US Oncology’s Shared Values.

The US Oncology Network is a thriving organization that fosters forward-thinking, advancement opportunities, and an inspired work environment. We continuously look for top talent to propel our organization forward and celebrate new successes. Join our team in the fight against cancer.

About US Oncology

The US Oncology Network is one of the nation’s largest networks of community-based oncology physicians dedicated to advancing cancer care in America. Supported by McKesson Corporation, we focus on empowering a vibrant and sustainable community patient care delivery system to advance the science, technology, and quality of care. For more information, visit www.usoncology.com.

Responsibilities

• Research and obtain accurate and current insurance coverage information; make corresponding corrections in the PMS.
• Evaluate benefits and eligibility to assess patient financial responsibility.
• Coordinate referrals from primary care clinics to ensure appropriate authorizations are secured and entered into the PMS.
• Identify uninsured patients and refer them to a patient benefit representative for coordination of payment.
• Communicate system issues and/or payor trends to lead or supervisor.
• Answer questions and resolve complaints.
• Document conversations with payors in the PMS.
• Contact and follow up with clinics regarding any missing or incomplete documentation.
• Work TES Edits.
• Research and respond to routine account inquiries; take appropriate action and escalate non-routine issues.
• Adhere to confidentiality, state, federal, and HIPAA laws and guidelines regarding patient records and collections.
• Perform other duties as requested or assigned.

Requirements

• High school diploma or equivalent required.
• Entry-level position requiring zero (0) to two (2) years of experience with front desk, registrations, healthcare benefits, or equivalent.
• Proficiency with computer systems and Microsoft Office (Word and Excel) required.

Skills

• Analytical and problem-solving skills for resolving eligibility variances.
• Strong communication skills for direct contact with patients and payors.
• Attention to detail for accurate documentation in the PMS.
• Ability to adhere to confidentiality and compliance guidelines.

Benefits

• Medical, Dental, and Vision Plan
• 401(k) with a matching component
• Life Insurance
• Short-term and Long-term Disability
• Paid Time Off (PTO) and Paid Holidays
• Wellness & Perks Programs

Pay

$21–24 per hour, depending on experience

Physical Demands

• Required to be present at the employee site during regularly scheduled business hours.
• Regularly required to sit or stand, talk, or hear.
• Requires full range of body motion, including handling and lifting patients, manual and finger dexterity, and eye-hand coordination.
• Requires standing and walking for extensive periods of time.
• Occasionally lifts and carries items weighing up to 40 lbs.
• Requires corrected vision and hearing to normal range.

Work Environment

• May include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment.
• Work may involve in-person interaction with co-workers, management, and/or clients.
• May require minimal travel by automobile to office sites.