Eligibility and Risk Specialist

Shield California Health•Santa Clarita, CA

1d•$19 - $20•Onsite

About The Position

Shield HealthCare is looking for an Eligibility and Risk Specialist in Valencia, CA responsible for verifying eligibility and risk delegation for health plan members and properly maintaining customer records. Research related rejections and denials and make the necessary corrections to meet billing guidelines or recommend claims for write-off. This position is on-site in Valencia, CA.

Requirements

Proficiency in Microsoft Office with experience working in Microsoft Excel
Must be detail oriented, thorough, accurate, and organized
Proven ability to research and solve problems
Good written and verbal communication skills

Nice To Haves

Familiarity with various medical insurance payer guidelines/billing requirements preferred

Responsibilities

Responsible for verifying eligibility and risk delegation for health plan members and properly maintaining the customer records
Ensure that all eligibility verification requests are completed in a timely manner
Research problems and find solutions to eligibility related claim rejections and denials
Inform management of changes or trends with eligibility and risk issues
Research denials and billing requirements of third-party carriers utilizing web portals, phone contact, EOBs, provider manuals, etc.
Adjudicate claims issues by preparing and submitting corrected claims or appeals
Recommend claims for write-off when billing requirements are not met
Effectively communicate by phone, email, and in-person with third-party payers and internal staff to resolve eligibility issues and establish positive relationships
Accurately update and notate accounts receivable system, collections notepad, and customer accounts
Remain updated on company policies and procedures and third-party payer guidelines, bulletins, and billing requirements
Work reports and projects assigned by management
Ensure appropriate follow-up and timely completion of assignments