Eligibility Specialist

JOB SUMMARY:

The Eligibility Specialist has the responsibility for reviewing patients' insurance to verify their eligibility for qualifying insurance coverage prior patient's visit and updating the insurance information into patients' profile. This position will assist the management team with oversight of both the patient eligibility and patient application processes by serving as a liaison between the client and other departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Determine if re-authorization needed for new order
• Verify insurance eligibility
• Call insurance companies to ascertain pertinent information regarding policies and payment benefits for patient
• Instruct patients on amounts covered under benefits plan in easy to understand terminology
• Retain strong medical terminology understanding in effort to better comprehend procedures
• Follow Specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information
• Sign payment approvals accepted claims
• Update all patient and insurance data regularly and carefully inputted changes into company's computer system
• Handle billing related activities focused on medical specialties
• Examine claims, records and procedures to grant approval of coverage
• Check documentation for appropriate coding, catching errors and making revisions
• Verify that patient had proper insurance coverage prior to any procedures or appointment scheduling
• Create and maintain accurate and confidential patient files according to regulatory mandates
• Update patient financial information to promote accurate record keeping
• Perform all other duties as directed either formally or informally, verbally or in writing

SUPERVISORY RESPONSIBILITIES:

No direct supervisory responsibilities

KNOWLEDGE, SKILLS AND ABILITIES:

• Working knowledge of medical terminology.
• Must be able to work independently while utilizing strong critical thinking/time management skills.
• Must be able to type 45 words per minute.
• Strong computer skills, with proficiency in Microsoft Office.
• Must possess good "customer service" including verbal and written communication.
• A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times.
• Possess strong interpersonal skills and ability to work well with others.
• Ability to deal effectively with changing situations and stressful environment.
• Ability to perform tasks related to physical activity to complete the responsibilities of the position

EXPERIENCE AND EDUCATION:

• High School graduate or equivalent
• Associate's Degree in a related field and/or Medical Billing Certificate from an accredited school preferred
• Minimum 1 year of experience in medical billing, medical insurance and/or customer service