Patient Eligibility Specialist

About the role

Key contributor to clinical and revenue cycle operations, a Patient Eligibility Specialist plays a pivotal role in managing patient information, verifying patient treatment eligibility through meticulous insurance processes, and supporting patient care through the accurate preparation of medical charts. This role demands a dynamic individual capable of navigating complex insurance systems and contributing positively to team dynamics.

Responsibilities

• Confirm patient insurance details, including detailed benefits and referrals, to ensure eligibility and secure financial reimbursement ahead of service delivery.
• Analyze patient information to verify the appropriateness of appointment types, employing analytical skills for optimal scheduling.
• Prepare and review electronic medical charts, understanding minimal clinical requirements to match treatments with diagnoses.
• Accurately gather and verify all patient demographic, financial, and insurance information, ensuring comprehensive financial clearance. This includes obtaining necessary referrals, authorizations, and pre-certifications to mitigate denials and secure reimbursement.
• Inform patients/guarantors about their benefits, authorization needs, and out-of-pocket responsibilities, including co-pays, deductibles, and co-insurance.
• Efficiently manage prior authorization demands, including reviewing patient diagnoses, communicating with insurance carriers, and utilizing insurance portals for submission.
• Maintain patient confidentiality, contribute positively to team dynamics, and engage in continuous professional development through meetings and seminars.
• Maintain a high level of confidentiality regarding legal matters, privacy issues, and data integrity.
• Other duties as assigned; aids with ad-hoc, special projects, as needed.

Requirements

• High School Diploma or GED required.
• 1+ years of experience and knowledge in medical services profession, insurance plans, revenue cycle, or a combination of all.
• Familiarity with Practice Management systems.
• Prior healthcare experience.
• Familiarity with insurance referral and reimbursement criteria.

Skills

• Accountability – Ability to accept responsibility and account for actions and work performed. Willing to accept constructive feedback.
• Accuracy – Ability to perform work accurately and thoroughly with attention to all details.
• Adaptability – Ability to adapt to and facilitate change in the workplace.
• Communication – Ability to communicate effectively with others using good listening skills.
• Empathy – Ability to appreciate and be sensitive to the feelings of patients and co-workers.
• Initiative – Ability to make decisions and take actions to solve a problem or reach a goal. Desire to excel, attempting non-routine tasks.
• Judgment – Ability to make sound decisions using available information.
• Reliability – Can be relied upon to demonstrate reliability in attendance and punctuality.
• Team Player – The ability to work with others and independently for a common goal. Puts aside own individual needs to work toward the larger group objective and reinforces the contribution of others.
• Exceptional verbal and written communication skills.
• Strong critical thinking, analytical, and problem-solving abilities, coupled with excellent patient care orientation.
• Excellent interpersonal skills and ability to work effectively with physicians, co-workers, other departments, and patients of all ages, and from across a broad range of cultural and socioeconomic backgrounds.
• Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in accordance with established policies and HIPAA regulations.
• Personable, outgoing, and friendly, fostering positive interactions and relationships.
• Demonstrates flexibility and adaptability, capable of thriving independently and as an integral part of a team in dynamic environments.
• Ability to work independently in a fast-paced environment, maintaining professionalism and confidentiality in line with HIPAA regulations.
• High proficiency in Microsoft Office Suite, especially Excel, and the ability to navigate and master various electronic systems.
• Computer proficiency in Microsoft Office (Word, Excel, PowerPoint).

Pay

Compensation Range: $18-$35.50/hr (dependent on experience).

Work Environment

An office environment with a controlled atmosphere at our New Providence CBO location. This is a non-exempt, on-site role and is part of Prism Vision Group.