The Eligibility Specialist gathers, researches, and updates insurance eligibility received from patients, and insurance companies to maintain accurate information for claims processing.

Essential Duties and Responsibilities:

• Uses EMR and payor Portals to perform eligibility checks.
• Obtain benefit information as well as identify the PCP (Southeast Region Only)
• Ensures that each appointment is reviewed for a valid referral the day before the appointment
• Reviews each referral to ensure the information listed is accurate and complete, and tracks and monitors referrals for expiration
• Runs and reviews each schedule daily for appointments deletions and additions, at least three (3) days in advance of the appointment date
• Takes payments via phone.
• Processes daily correspondence.
• Answers billing questions and inquiries from patients and internal staff. Inquiries/questions may come in via the EMR task bucket or via phone.
• Updates patient files with address changes, contact information changes, etc., as needed.
• Creates, maintains and updates reports, as directed.
• Update Phreesia with patient financial balance information
• Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.
• Verifies insurance benefits for office visits.
• Coordinates with insurance providers, physicians and patients to obtain approval to be seen in an office setting. Documents these findings in patient charts.
• Reviews clinical data matching it against specified medical terms and diagnoses and follow established visits for authorizing request.
• Coordinates with physicians, insurance companies and patients.
• Works as patient liaison between the insurance companies and the physicians at the Company
• Checks work e-mail on a regular basis throughout the workday.
• Participates in and complete all required trainings and in-services.
• Performs other duties as assigned.

Minimum Qualifications:

• High School Diploma, or equivalent.
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Must have excellent written and oral communication skills, including exceptional customer service.
• Must be able to establish and maintain effective working relationships with doctors, clinical staff, other co-workers and the public.
• Must be able to work individually as well as within a team.
• Must be able to follow both verbal and written instructions.
• Must be able to work a flexible schedule.
• Must be able to respond with patience and understanding during stressful conditions related to patient health and emergent situations.
• Must be able to multi-task and prioritize.
• Must demonstrate extreme attention to detail.
• Must possess strong organization skills.
• Must be able to problem solve and use reasoning.
• Must be able to meet predefined quality standards.
• Must maintain and project a professional attitude and appearance at all time.
• Must have a working knowledge of the healthcare field and medical specialty, as well as medical terminology.
• Must have a working knowledge of CPT and ICD-10 coding rules.
• Must have a solid foundation of insurance knowledge and guidelines for third party payers.
• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

• Three (3) years' related experience
• One (1) year experience working with an Electronic Medical Record (EMR).

Driving/Travel:

The employee must have reliable transportation. While the primary workplace may be closest to the employee’s home, work assignments could be in any of the Company’s locations.

Compensation and Benefits:

• Pay Range: $17.00/Hr - $20.00/Hr
• PTO: Up to 96 hours in first year (pro-rated based on start date)
• Holidays: 7 (New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day)
• Retirement: 401(k) with employer match
• Health Benefits: Medical (single and family), Dental (single and family), Vision (single and family)
• Other Company-Paid Benefits: Basic Life/AD&D, Employee Assistance Program
• Other Voluntary Benefits: Short-Term Disability, Long-Term Disability, Voluntary Life, Accident, Critical Illness, Hospital Indemnity