Title: Eligibility Coordinator
Handling internal and external inquiries regarding eligibility status, benefits, co-payments, co-insurance, deductibles, etc. thru internal system, plan website, designated portals and/or thru direct contact with the plans; Documenting inquires and responses in the system and making changes to member records per department policy and guideline;
Essential Duties and Responsibilities
- Handles phone calls professionally and courteously
- Documents member or provider calls in the system.
- Utilizes available resources to verify and document co-payment, coinsurance and deductible amounts due at time of service.
- Updates eligibility information - makes additions, changes, and terminations timely and accurately.
- Advises management on issues and opportunities regarding workflows.
- Fixes EDI errors of “Member Can’t Find”.
- Maintains all practices to protect PHI and follow HIPAA guidelines.
- Performs other duties/projects as assigned
- Good verbal and written communication skills
- Good customer service and problem-solving skills
- Knowledge of managed care and HMO products
- Knowledge of medical terminology
- Proficient in Microsoft applications
Job Type: Full-time
Experience: Minimum 2 years of healthcare-related experience
- Medical Terminology: 2 year (Preferred)
- Microsoft Office: 1 year (Preferred)
- Managed Care: 1 year (Preferred)
- High school or equivalent (Preferred)
IF YOU ARE INTERESTED AND QUALIFIED, PLEASE APPLY IMMEDIATELY. QUESTIONS CAN BE DIRECTED TO CRISTINA DAVIS AT
- Complex Problem Solving
- Health Care
- Managed Care