Eligibility Specialist (FT) - Remote

Optim•Savannah, GA

12d•Remote

About The Position

Optim Orthopedics is seeking a full-time, remote Eligibility Specialist. The role reviews patient eligibility, insurance benefits, and authorizations for upcoming appointments; updates patient account information; supports patients and staff with insurance and billing questions; and maintains accurate, confidential documentation in electronic systems. The specialist follows organizational procedures and compliance requirements, promotes patient safety and positive patient experiences, and may provide backup support for other Front Office positions. Other duties may be assigned.

Requirements

Comprehensive understanding and knowledge of the insurance claim process, EOBs, and patient statements.
Ability to maintain accuracy in demographic information and data entry in an EMR system.
Ability to use electronic systems, including email, a Practice Management System, and an EMR.
Ability to maintain professional and respectful documentation in patient records.
Ability to respond to patient calls professionally and document interactions appropriately.
Must protect confidential patient information and comply with HIPAA and applicable state and federal laws.
Must complete applicable annual compliance and regulatory requirements and follow organizational procedures.

Responsibilities

Review clinic schedules 48 hours before appointments at designated locations and verify that patient insurance is active and benefits are available.
Contact patients in advance when insurance issues may affect their appointments.
Update copay information in Athena and document coinsurance, deductibles, and balances due for the front desk.
Monitor the EMR eligibility bucket and review insurance eligibility and benefits for upcoming appointments.
Monitor the EBT email group daily and assist Patient Access Coordinators with eligibility issues identified during appointment scheduling.
Verify that authorizations are obtained and attached to the appropriate appointment to support accurate claim submission.
Assist Patient Account Coordinators with setting up payment plans as needed.
Identify and communicate trends, denial issues, irregularities, or workflow concerns to the supervisor and team, and recommend resolutions.
Use knowledge of claims, EOBs, and patient statements to help patients with questions.
Forward identified billing issues to appropriate staff for resolution.
Maintain current knowledge of third-party billing and reimbursement, clinic financial policies, and industry practices.
Maintain accurate demographic information and data entry in the EMR.
Use email, the Practice Management System, and EMR to communicate with staff and maintain accurate, professional patient records.
Respond to patient calls in a timely and professional manner and document them appropriately in the patient chart.
Complete applicable annual compliance and regulatory requirements and follow organizational work processes, procedures, rules, and regulations.
Protect confidential patient information in accordance with HIPAA and applicable state and federal laws, and uphold patient safety and quality.
Take ownership of assigned tasks, support the company's reputation, and escalate problems to the Manager or Supervisor as appropriate.
Demonstrate and encourage teamwork and exceptional patient and guest experiences.
Provide backup for other Front Office positions, including check-in or check-out, as needed.
Perform other duties as assigned.