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Eligibility Specialist

Eligibility Specialist

Job Description

 The Eligiblity Specialist will serve a key role as a member of our Charlotte Team.  The ideal candidate will have experience in determining and processing medical eligibility for our patients.  Ensuring patient information and eligibility have been accurately verified and recorded in our Practice Management database.  The ideal candidate will have a passion for providing exceptional customer service to all of our clients, internal and external. WESTMED Practice Partners Eligibility Department is a centralized service.  We serve as Subject Matter Experts for our internal customers providing information and assistance regarding difficult insurance inquiries.

Essential Functions and Job Responsibilities

The incumbent will be responsible for:

  • Ensuring insurance verification is validated with the appropriate insurance carrier employing multiple methods such as electronic submissions to our clearinghouse, manual submissions processed through insurance websites, and/or by telephone. 
  • Verifying medical coverage prior to scheduled appointments and ensuring that certain preventive and specialty benefits are thoroughly reviewed. 
  • Notifying our patients of any insurance issues and resolving prior to their scheduled appointment.
  • Completing assigned special projects as needed these can include but are not limited to research projects pertaining to insurance company benefit guidelines and requirements.

Working Hours: Monday – Friday, 8am-5pm

Job Requirements


  • High School Diploma or equivalent, Associates Degree preferred
  • Strong interpersonal skills
  • Exceptional communication and customer service skills
  • Working knowledge of insurance verification and medical office procedures
  • Strong time management skills, the ability to plan, prioritize and complete delegated tasks within the expected time line
  • Microsoft Office Experience
  • Proficient keyboarding skills
  • Ability to adapt to changing workflows, processes and work queues
  • Ability to support team, departmental and organizational protocols, workflows, policies and procedures


Job Snapshot

Other Pay Competitive Salary
Employment Type Full-Time
Job Type Health Care, Insurance
Education High School
Experience 2 to 5 years
Manages Others No
Industry Healthcare - Health Services
Required Travel None
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Eligibility Specialist

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