Claims and Eligibility Specialist

CardioOne•Oakland, NJ

5d•Onsite

About The Position

Cardiac Associates of North Jersey, is seeking motivated individuals to join our team as a Claims and Eligibility Specialist. You will be responsible for verifying patient insurance coverage, obtaining benefit and authorization information, and ensuring accurate eligibility for medical services prior to treatment. This role works closely with patients, insurance companies, and healthcare providers to minimize claim denials and ensure accurate billing and reimbursement.You will report directly to the Practice Manager. Schedule: Monday through Friday, no weekends, 7:30AM to 4:30 PM. Compensation: $23.50 per hour, dependent on experience.

Requirements

Minimum of 1–2 years of experience in medical insurance verification, medical billing, or healthcare administration
Knowledge of commercial insurance, Medicare, Medicaid, and managed care plans
Strong computer skills and experience with EMR/practice management systems
Excellent communication, organizational, and customer service skills
Ability to multitask and work in a fast-paced healthcare environment
Attention to detail and accuracy
Strong problem-solving abilities
Ability to maintain confidentiality
Professional phone etiquette
Time management and organizational skills
Team-oriented mindset with the ability to work independently

Nice To Haves

High school diploma or equivalent required; and/or billing certification preferred
Familiarity with CPT, ICD-10, and authorization processes preferred
Knowledge and use of EHRs (Athena experience is a plus!)

Responsibilities

Verify patient insurance eligibility and benefits for scheduled procedures and office visits
Obtain and document pre-authorizations and referrals when required
Review patient demographic and insurance information for accuracy
Contact insurance companies to confirm coverage, deductibles, co-pays, co-insurance, and out-of-pocket responsibilities
Contact patients regarding outstanding balances and arrange payment collection when necessary
Communicate financial responsibility and estimated costs to patients professionally and compassionately
Update electronic medical records (EMR) and billing systems with verified insurance information
Resolve insurance discrepancies and coverage issues prior to services being rendered
Work closely with front desk staff, billing department, and clinical teams to ensure smooth patient processing
Maintain compliance with HIPAA and all insurance regulations
Assist with claim follow-up and denial prevention as needed
Other duties as assigned