Eligibility Specialist

The US Oncology Network•Ocala, FL

6d•Onsite

About The Position

Under general supervision, the Eligibility Specialist is responsible for the successful resubmission of invoices to the responsible party. The role analyzes and resolves eligibility variances through web research and/or direct contact with patients, and coordinates the acquisition of referrals and retro-authorizations where applicable. The position follows standard procedures and pre-established guidelines and supports and adheres to the US Oncology Compliance Program, including its Code of Ethics and Business Standards and Shared Values. The role requires presence at the employee site during regularly scheduled business hours. The work environment may involve exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic. Work includes in-person interaction with coworkers, management, and/or clients, and may require minimal automobile travel to office sites.

Requirements

High school diploma or equivalent required.
Three years of experience with front desk, registrations, healthcare benefits, or equivalent experience required.
Proficiency with computer systems and Microsoft Office (Word and Excel) required.
Ability to meet the physical demands of the role, including sitting or standing, talking or hearing, a full range of body motion, handling and lifting patients, manual and finger dexterity, eye-hand coordination, extensive standing and walking, and occasionally lifting and carrying items up to 40 pounds.
Corrected vision and hearing to the normal range are required.

Nice To Haves

Associate degree preferred.

Responsibilities

Research and obtain accurate, current insurance coverage information and make corresponding corrections in the PMS.
Evaluate benefits and eligibility to assess patient financial responsibility, when applicable.
Coordinate referrals from primary care clinics to ensure appropriate authorizations are secured and entered into the PMS, when applicable.
Identify uninsured patients and refer them to a patient benefit representative for payment coordination.
Communicate system issues and/or payor trends to a lead or supervisor.
Answer questions and resolve complaints, when applicable.
Document conversations with payors in the PMS.
Contact and follow up with clinics regarding missing or incomplete documentation.
Work ETM and TES edits.
Manage complex payor eligibility and referrals.
Research and respond to routine account inquiries and take appropriate action; escalate non-routine issues and recommend solutions to unique situations.
Identify processes and procedures to improve efficiencies.
Adhere to confidentiality requirements and state, federal, and HIPAA laws and guidelines regarding patient records and collections.
Perform other duties as requested or assigned.