Billing and Eligibility Specialist

Envision Unlimited•Chicago, IL

4d•Hybrid

About The Position

The Billing and Eligibility Specialist is responsible for managing critical aspects of the revenue cycle, including client eligibility monitoring, financial registration, prior authorizations, claims management, and other general RCM duties. This position plays a critical role in protecting organizational revenue by ensuring accurate and continuous patient insurance coverage, with a primary focus on Medicaid eligibility management. This role combines traditional billing functions with proactive eligibility monitoring, working to prevent revenue loss associated with coverage gaps, policy changes, and increased Medicaid redetermination requirements. This position serves as a key liaison between front-end operations, clinical teams, and the revenue cycle department to identify and resolve coverage issues before, during, and after service delivery. A strong understanding of billing processes, insurance policies, and collections procedures is essential to this role, along with a keen ability to improve processes and maintain compliance with healthcare regulations. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Requirements

High school diploma or equivalent.
Minimum 2 years of experience in the healthcare industry, working with Medicaid, Medicare, Commercial Insurance, and/or Managed Care Organizations.
Knowledge of eligibility verification processes, insurance portals, and clearinghouses.
Educated in and compliant with HIPAA regulations.
Understand medical terminology and maintain strict confidentiality of client and client information.
Strong understanding of Microsoft applications, i.e. Excel, Outlook, and Word.
Experience working with Electronic Health Records Systems.
Ability to investigate problems and develop/communicate solutions.
Professional communication with staff and clients.

Nice To Haves

Associate or bachelor’s degree preferred.
One to three years of training and experience in Revenue Cycle functions highly preferred.

Responsibilities

Perform daily eligibility verification for scheduled patients, including batch and real-time checks
Monitor and track patients at risk of losing Medicaid coverage
Investigate and resolve eligibility discrepancies, including terminations, pending renewals, and MCO assignment issues
Collaborate with front desk and clinical staff to address eligibility issues prior to service delivery
Assist patients and/or staff with Medicaid renewal processes and documentation requirements
Maintain tracking logs for at-risk and inactive patients, including follow-up actions and outcomes
Participate in process improvement initiatives to strengthen front-end revenue cycle performance
Support training efforts related to eligibility verification and documentation requirements
Assist the Intake Department by registering new clients and ensuring accurate financial information is captured.
Help clients and staff with applying for the Sliding Fee Discount Program.
Update client financial records when insurance changes occur, ensuring accurate documentation and compliance.
Manage Registrations with the IL Mental Health Collaborative by registering new Medicaid clients, re-registering existing clients, and closing registrations for discharged clients
Generate client statements for those with outstanding balances or Medicaid Spenddown requirements.
Follow up on overdue accounts, sending reminders and contacting clients to ensure timely payment.
Establish and manage payment plans for clients with outstanding balances.
Communicate with health care providers, clients, insurance claim representatives, and other parties to clarify billing issues and facilitate timely payment.
Submit and monitor claims for accuracy and timeliness
Conduct pre-bill eligibility checks to ensure claims are submitted only for active coverage periods
Identify and hold claims with eligibility concerns for further review
Post payments and assist with reconciliation processes as needed
Work eligibility-related denials, including “coverage terminated,” “member not eligible,” and similar issues
Research and resolve denied claims through re-verification, payer outreach, and resubmission
Track trends in eligibility-related denials and report findings to leadership
Assist with recovery of revenue through retroactive eligibility verification when applicable
Assist Director with managing the contracting process to ensure providers are in network with insurance companies, MCOs and Medicare
Coordinate with payers and leadership to finalize contracts, ensuring timely execution.
Oversee the credentialing process, ensuring all required staff documentation (e.g., licenses, certifications) is up to date.
Submit credentialing applications to insurance companies, track approval status, and resolve any issues promptly.
Maintain accurate records of credentialing documents to ensure compliance.
Perform other related duties and/or projects as assigned

Benefits

Blue Cross/Blue Shield Medical Coverage: HMO, PPO
Dental and Vision Insurance Options
Company paid Life and LTD Insurance
Voluntary plans (Pet insurance, AD&D, Life, Critical Illness, Short Term Disability)
11 Paid Holidays
Paid vacation, sick time and personal days
403B plan
In house training and CEU’s
Employee Assistance Network
Support for pursuing clinical licensure (financial and time off)
Opportunity for career growth & development