Eligibility Specialist II

Status: FT – 40 hrs.

Submit resumes to:  jramirezsacasa@davisstreet.org

POSITION SUMMARY

Under direct supervision of the COM, the Eligibility Specialist II is responsible for the resolution of insurance eligibility denials through various methods such as website research, calling insurance companies to verify coverage and benefits or by contacting the facility and/or the patient. The position works in a cooperative team environment to provide value to customers (internal and external). The Eligibility Specialist carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of Davis Street while adhering to the Davis Street office policies and procedures with the goal of fostering an environment which promotes patient comfort and trust.

 

RESPONSIBILITIES

  • Responsible for contacting insurance companies and navigating payer websites to obtain accurate status information of outstanding claims and inputs accurate information into the computer billing system.
  • Responsible for having working knowledge of payer eligibility and benefits verification/billing guidelines. Has complete understanding and working knowledge of navigating payer websites.
  • Assisting in identifying and resolving payer trends and issues related to eligibility denials and rejections.
  • Responsible for verifying dental and medical coverage and enrollment
  • Review financial status of treatment plan with patient as indicated by provider
  • Process Sliding Scale applications and obtain approval from finance
  • Update patient EHR with new dental and medical coverage
  • Obtain patient sign agreement of financial responsibility and treatment plans. Ensure proper payment is received by appropriate deadlines
  • Participates in outreach community events to engage and enroll patients in HealthPac
  • Assist in the clinic reception desk by completing patient registration, check in appointments, making follow-up appointments, and other duties as assigned.
  • Researches insurance eligibility via website or by calling the insurance company, patient, or hospital in order to resolve eligibility denials/rejections in a timely and accurate manner.
  • Maintains thorough and detailed knowledge of various insurance contracts and eligibility denials and follow up guidelines.
  • Maintains confidentiality in accordance with HIPAA
  • Correct and repost claims as requested by billing department with correct patient information.
  • Maintains good working knowledge of the contract tables and PPS Rate plans.
  • Responsible for submitting corrected claims to appropriate payers in a timely manner if needed.
  • Responsible for all daily productivity reporting requirements.
  • Maintains and exceeds department standards for productivity and quality
  • Ensures compliance with state and federal laws and regulations for Commercial, Medicare, Medicaid, Managed Care and other payers.
  • Coordinate internal referrals to Basic Needs, Children Services and other Davis Street Programs
  • Follow up with department managers
  • Maintains ongoing knowledge of Health Resources Services Administrative (HRSA) and other mandatory state billing forms and filling and follow up requirements and ensures compliance and adherence to guidelines.
  • Continually seeks to understand and act upon employer/customer needs, concerns, and priorities. Meets employer/customer expectations and requirements, and gains employer/customer trust and respect.
  • Assist patients in the enrollment of local, state, and federal programs.
  • Performs day-to-day administrative functions and general office duties
  • Performs EHR/eCW data entry duties.
  • Other duties as assigned

 

REQUIREMENTS

  • 1-2 years experience in a clinical environment
  • High School Diploma or GED required, AA or BA preferred
  • Medical Assistant or Dental Assistant experience preferred
  • Prior administrative or clerical experience in a clinical or community-based setting
  • Bilingual in Spanish helpful
  • Intermediate to advanced phone and computer skills
  • Willingness to work periodic Saturday events
  • Excellent customer service and interpersonal communication skills
  • Cultural sensitivity and demonstrated ability to work with diverse people groups.
  • Ability to work with minimal supervision.
  • Ability to type a minimum of 45 WPM
  • Commitment to the mission and values of Davis Street