Eligibility Specialist

Florida Cancer Specialists•Nine Mile, FL

1d•Onsite

About The Position

Under direct supervision, is responsible for the successful resubmission of invoices to the responsible party. Analyzes and resolves eligibility variances via web research and/or direct contact with patients. Coordinates the activities for the acquisition of referrals and retro-authorizations, where applicable. Follows standard procedures and pre-established guidelines to complete tasks. 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.
Position is entry level and requires zero (0) to two (2) years with front desk, registrations, healthcare benefits or equivalent experience.
Proficiency with computer systems and Microsoft Office (Word and Excel) required.

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 coordinates 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 lead or supervisor.
May answer questions and resolve complaints.
Documents conversations with payors in the PMS.
Contacts and follows up with clinic or any missing or incomplete documentation.
Works TES Edits.
Researches and responds to routine account inquiries and takes appropriate action; escalates non-routine issues.
Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient’s records and collections.
Other duties as requested or assigned.