Inpatient Eligibility Specialist

Position Details

Maintains accountability for timely follow-up, complete application processing, and accurate system documentation to support successful approvals.

Employment Qualifications

• Minimum Education: High School Diploma or GED
• Minimum Years and Type of Experience: 1-2 years of experience in the healthcare industry, social work, or case management environment, interacting with patients regarding financial concerns, working with self-pay, underinsured, or a compromised population in a face-to-face customer service capacity
• Proactive explanation of complicated programs

Other Knowledge, Skills And Abilities

• Preferred understanding of Revenue Cycle functions including billing, payments, denials, authorizations, and benefit verifications
• Knowledge of health insurance requirements
• Knowledge of medical terminology
• Experience with managed care/insurance knowledge
• Ability to comprehend various state Medicaid plan qualifications and communicate patient benefits clearly and effectively to those most likely to benefit
• Good math skills and ability to identify best program for an applicant out of those available
• Complete written applications with patients to submit to state agencies and ensure the supporting documents will be provided timely
• Customer service ability, strong face to face communication skills, background working with customers or patients on document completion and applications, knowledge of medical expenses and associated bills, knowledge of patient insurance, ability to multitask, ability to learn complex state requirements for programs and explain to patients, bias for action, patient/consumer-focused, entrepreneurial and commitment to excellence and service