Eligibility Specialist

The US Oncology Network•Ocala, FL

1d•Onsite

About The Position

Under general supervision, this role is responsible for the successful resubmission of invoices to the responsible party. The Eligibility Specialist analyzes and resolves eligibility variances via web research and/or direct contact with patients. This role also coordinates the activities for the acquisition of referrals and retro-authorizations, where applicable. The position follows standard procedures and pre-established guidelines to complete tasks and supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology’s Shared Values.

Requirements

High school diploma or equivalent required.
Three (3) years with front desk, registrations, healthcare benefits or equivalent experience.
Proficiency with computer systems and Microsoft Office (Word and Excel) required.
Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; accesses and uses other expert resources when appropriate.
Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility.
Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty.
Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them.
Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies.
Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient’s records and collections.

Nice To Haves

Associates degree preferred.

Responsibilities

Researches and obtain accurate and current insurance coverage information, makes corresponding corrections in the PMS.
May evaluate benefits and eligibility to assess patient financial responsibility.
May coordinate referral from primary care clinic to ensure appropriate authorizations are secured and entered into the PMS.
Identifies uninsured patients and refers to patient benefit representative for coordination of payment.
Communicates system issues and/or payor trends to lead or supervisor.
May answer questions and resolve complaints.
Documents conversations with payors in the PMS.
Contacts and follows up with clinic for any missing or incomplete documentation.
Works ETM and TES edits.
Manages complex payor eligibility and referrals.
Researches and responds to routine account inquiries and takes appropriate action; escalates non-routine issues, makes recommendations for solutions to unique situations.
Identifies processes and procedures to improve efficiencies.
Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient’s records and collections.
Other duties as requested or assigned.