Patient Support Services - Eligibility Team (Full-Time)

Hudson Headwaters Health Network•Town of Queensbury, NY

About The Position

The Patient Support Services Representative on the Eligibility Team handles patient phone calls, insurance correspondence, billing trend identification, and other assigned duties. The role supports internal and external inquiries professionally and in accordance with HIPAA guidelines, helps maintain accurate demographic and insurance data, and supports Network staff with information and education about participating insurance plans, eligibility, claims inquiries, adjustments, and appeals. The representative oversees assigned work queues and correspondence, including hold and MGRHOLD buckets, the correspondence dashboard, unpostable accounts, faxes, and mail. The position also works with insurers and patients to resolve claims, facilitate refunds and credit balances in accordance with Network policy, collect and post insurance payments, complete deposits, respond to billing correspondence, and coordinate with collection, coding, and billing vendors. The role supports the Mission, Vision, and Core Values of Hudson Headwaters Health Network and may include additional duties and special projects as assigned.

Requirements

High school diploma or general education degree (GED).
At least three years of billing experience or an equivalent combination of education and experience.
Strong customer service skills.
Strong organizational skills.
Ability to work with a variety of groups, including managers, patients, insurance representatives, and other departments.
Ability to interact professionally and efficiently.
Excellent computer skills, including proficiency in Excel and Word.

Nice To Haves

Certified Professional Coder certification is preferred but not required.
Experience with Athena is a plus.

Responsibilities

Handle patient phone calls, insurance correspondence, billing trend identification, and other assigned duties.
Respond to internal and external inquiries professionally, courteously, and in accordance with HIPAA guidelines.
Verify demographic and insurance information to support data quality.
Communicate with and educate Network staff as needed about participating insurances, eligibility status, claims inquiries, adjustments, and appeals.
Oversee assigned hold, MGRHOLD, and other work buckets.
Oversee the correspondence dashboard, unpostable accounts, faxes, and mail.
Understand carrier refund processes and facilitate credit balances in accordance with Network policy.
Work with insurance companies and patients to resolve claims and stay current on changes with insurance companies.
Call insurance companies and work with provider relations representatives.
Collect and post insurance payments and complete deposits.
Respond to internal and external correspondence regarding billing issues.
Liaise with collection, coding, and billing vendors.
Support the Mission, Vision, and Core Values of Hudson Headwaters Health Network.
Perform additional duties and special projects as assigned.