D201 - Eligibility Specialist

River Edge•Macon, GA

52d

About The Position

River Edge Behavioral Health is actively seeking an Eligibility Specialist to join our dedicated team, ideally possessing attention to detail, strong analytical skills, effective communication, a team player mentality, adaptability, problem-solving abilities, ethical conduct, and organizational skills. Schedule: Monday to Friday: 8:30am- 5:00pm FLSA Classification: Hourly, Non-Exempt

Requirements

High School Diploma or GED.
2-3 years of knowledge and experience in third-party payer and insurance verification.
Minimum of two (2) years of customer service experience in a medical office environment.
Ability to thrive in a fast-paced work environment, with strong organizational skills to manage multiple tasks efficiently.
All applicants must pass a satisfactory background clearance and pre-employment drug test.
Provide two (2) Professional Reference Statements (Former employers only; no family members).

Responsibilities

Verify all commercial insurance, Medicaid, Medicare, and state program coverage to determine patient responsibility.
Ensure client records contain up-to-date payer information, including authorization, Connects, treatment plan, Intake Assessment, annual updates, financial application, ANSA, or CANS.
Update all third-party payer information in the clinical record, as necessary.
Obtain prior authorization (non-clinical), if required.
Determine third-party liability and co-payment, if applicable, and update the clinical record accordingly.
Maintain accurate and current payer information in the clinical record to facilitate timely submission to all payors.
Provide assistance to front desk staff as needed regarding insurance co-payments and coinsurance questions.