Eligibility Specialist Jobs

About The Position

Requirements

• Experience with eligibility and registration, as specified in the job title.
• Strong problem-solving and critical-thinking skills.
• Ability to manage confidential information sensitively and discreetly in a HIPAA-compliant manner.
• Ability to take initiative, accept direction, and seek guidance appropriately.

Responsibilities

• Submit accurate and timely electronic and paper claims to assigned community, government, and commercial health plans.
• Submit timely, accurate, non-complex reconsiderations and appeals through paper, fax, or web portals.
• Monitor, research, and resolve unpaid, rejected, denied, and allowance-discrepancy claims.
• Perform assigned account follow-up and collections, analyze accounts, and determine appropriate actions for resolution.
• Document collection activities accurately and thoroughly in the billing system.
• Resolve denied or rejected invoices and allowance discrepancies; prepare payer corrections and appeals according to payer requirements.
• Use clinical applications, payer websites, and other systems to retrieve medical documentation, eligibility information, billing guidelines, referrals, and authorization information to support corrected claims, appeals, and coding reviews.
• Review undistributed payments at the account level and apply them to open balances when appropriate for assigned payers.
• Review and resolve incoming correspondence.
• Identify, prepare, and appropriately request adjustments.
• Respond to inquiries from patients, insurance companies, public agencies, internal departments, and third-party payers.
• Identify and resolve insurance setup errors to facilitate timely billing.
• Resolve charge review edits, claim edits, and clearinghouse and payer rejections to facilitate accurate billing, as assigned.
• Evaluate credit and balance accounts and take appropriate action, including issuing refunds or initiating payer recoupments through web portals.
• Evaluate accounts in allowance-discrepancy status against system-loaded contracts.
• Prepare appeals to pursue appropriate reimbursement from payers.
• Prepare adjusted or corrected bills, adjust accounts receivable entries, or prepare refunds in accordance with operating procedures, as needed.
• Answer calls coming into the department through a rotation line when required, and assist or direct callers to the appropriate representative.
• Perform other duties as assigned.
• Take initiative while accepting direction and seeking guidance appropriately.
• Manage confidential information sensitively and discreetly in a HIPAA-compliant manner.
• Work collaboratively with Billing, Coding, Cash Posting, and other departments to support correct claim processing and payment.

Benefits

• Comprehensive benefits package for team members and providers.