ELIGIBILITY SPECIALIST

Status: Full-time

Submit resumes to: calvarez@davisstreet.org

Summary

The Eligibility Specialist 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.
  • 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 good working knowledge of the contract tables and PPS Rate plans.
  • 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.
  • Performs day-to-day administrative functions and general office duties including but not limited to word processing, copying, filing, faxing, answering phones and data entry.
  • Performs EHR/eCW data entry duties.
  • Performs other duties, as required.

Qualifications

  • Must obtain CEC within 90 days of employment
  • Graduation from high school or equivalent plus 1-2 years of medical receptionist experience in comparable health care setting
  • Prior administrative or clerical experience in a clinical or community-based setting
  • Bilingual English/Spanish highly desirable
  • Exercise excellent customer services and interpersonal communication skills; Cultural sensitivity and demonstrated ability to work with diverse population
  • Excellent phone skills; able to effectively relate via the telephone and in-person to serve the needs of Clinic patients/clients/visitors in an efficient and productive manner
  • Ability to work with minimal supervision
  • Proven flexibility and willingness to handle a variety of tasks
  • Intermediate computer skills using MS Word, Excel and Outlook
  • Practices confidentiality and privacy protocols in accordance to Clinic policies and HIPAA requirements