Sr Eligibility Specialist RCM

The Sr. Eligibility Specialist, RCM, oversees the eligibility verification process within the revenue cycle, ensuring accurate and timely validation of patient insurance eligibility and benefits. This role manages complex eligibility cases, collaborates with payers, ensures compliance with insurance policies, and serves as a resource for junior team members.

Responsibilities

• Manage and oversee the verification of patient eligibility and benefits for all insurance payers, ensuring accuracy and completeness of information.
• Identify and resolve eligibility discrepancies to avoid delays in billing and reimbursement.
• Handle complex or escalated eligibility issues, collaborating with payers and other departments to resolve issues and ensure timely, accurate solutions.
• Provide mentorship and guidance to junior eligibility specialists, offering expertise in handling advanced problems and ensuring best practices are followed.
• Work closely with the billing, coding, and payer relations teams to proactively address eligibility and benefit verification issues.
• Maintain accurate and up-to-date eligibility information in payer systems and stay updated on changes in payer policies and insurance coverage requirements to mitigate claim denials.
• Generate and review reports related to eligibility verification, payer-specific trends, discrepancies, and best practices.
• Analyze reports on eligibility verification performance, identify trends and areas for improvement, and share insights with management.