Eligibility Specialist- Full-Time

Healthcare Outcomes Performance Co. (HOPCo) • Phoenix, AZ

9d • Onsite

About The Position

The Center for Orthopedic Research and Education (CORE Institute) is seeking an Eligibility Specialist to join their team. This role is responsible for verifying patient registration information, obtaining benefit verification and necessary authorizations, and ensuring accurate insurance eligibility. The specialist will also complete Explanation of Insurance Benefits forms, review insurance denials, and assist uninsured/underinsured patients. This position is part of the front office team and requires collaboration with multiple clinics and providers, as well as identifying trends and suggesting process improvements.

Requirements

• High school diploma/GED or equivalent working knowledge preferred.
• Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role that includes heavy insurance benefits verification experience.

Responsibilities

• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations (referrals, precertification, authorizations) prior to patient arrival for all Physical Therapy services.
• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
• Calls insurance companies to discuss physical therapy benefits and authorizations that are not available through online resources.
• Completes Explanation of Insurance Benefits form for patients, new patient paperwork, and serves as a member of the front office team to prep Front Office Reps for the patient’s arrival.
• Maintains proper Appointment Status settings for each visit, as well as ensures proper authorizations are secured prior to the patient visit.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Reviews insurance denials and rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding denials/rejections.
• Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.
• Engages in conversations with patients to review benefits, insurance requirements, and processed claims, and sets up payment options for anticipated/outstanding balances while providing excellent customer service.
• Assists uninsured/underinsured patients by screening for appropriate community resources such as Medicaid or charity assistance programs.
• Maintains satisfactory productivity rates and ensures the department VOB process is maintained within departmental guidelines of verifying benefits 3 weeks prior to the visit (except for add-ons).
• As part of the Physical Therapy front office team, the specialist will complete daily requests, work through obstacles to solve issues/problems for multiple clinics and providers, and cross-train to assist/fill in as front office support as needed to cover staff shortages or busy periods.
• Identifies and communicates trends and/or potential issues to the management team, and shares information with regard to payer rules and guidelines.
• Suggests process improvements and works as an integral team member of the front office team.
• Provides research, problem-solving, and reporting functions to assist management and front office team in meeting departmental metrics, quality standards, and enhanced operations.

Benefits

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED