Eligibility Specialist

SCP Health•Lafayette, LA

About The Position

The Eligibility Specialist accurately resolves registration and eligibility edits related to patient demographic and insurance information, following departmental policies and procedures and feedback from payors. The role supports chart flow through PreBilling, maintains inventory levels, and helps ensure timely, effective, and accurate chart processing while maximizing revenue.

Requirements

Detail-oriented and organized.
Self-motivated, with the ability to compile and track data to meet deadlines and goals.
Excellent interpersonal skills.
Ability to work effectively both individually and in a team environment.
Professional attitude and demeanor.
Written and oral communication skills.
Proficient computer knowledge of Word, Excel, Windows, and Outlook.
Quick learner with an aptitude for custom computer systems.
Previous success and comfort entering data for extended periods with limited interruptions.

Responsibilities

Update demographic and insurance information based on internal or payor feedback, using available records and resources such as face sheets, insurance cards, and eligibility results.
Determine the appropriate insurance carrier and billing information from the patient’s medical record and update the patient’s account in the billing system accurately.
Contact insurance carriers or facilities to obtain accurate information when medical-record data is insufficient or questionable.
Use the Eligibility process and data in Centricity or payor websites to obtain more accurate information for patients returned with an edit.
Request additional insurance company entries in Centricity when necessary.
Seek direction and clarification from a supervisor or lead when needed to resolve edits accurately.
Identify and work complex edits from various sources.
Identify and report user or system issues that affect billing quality.
Maintain understanding of current departmental policies and procedures.
Promote a team environment that supports department members’ growth and achievement of department goals.
Participate in meetings and educational programs to improve individual and team quality and effectiveness.