Eligibility Specialist Jobs

About The Position

Requirements

• High school diploma or GED required
• Minimum of 2–3 years of experience in insurance verification in a medical environment
• Data entry skills required; proficiency in 10-key by touch
• Strong organizational and follow-up skills
• Excellent written and verbal communication skills
• Strong customer service and interpersonal skills
• Ability to analyze situations and resolve issues quickly and accurately
• Ability to prioritize and handle multiple tasks in a fast-paced environment
• Ability to collaborate effectively across multiple teams
• Proficiency in computer applications, including EMR, PM systems, Microsoft Office, Outlook, and web portals
• Knowledge of insurance verification, patient eligibility, referrals, and healthcare billing processes

Responsibilities

• Verify insurance benefits for new patients, add-ons, and hospital surgeries
• Verify benefits on existing patients and update records as needed
• Enter and validate patient demographics and insurance in Practice Management (PM) and EMR systems
• Enter and verify copayments and financial information
• Contact primary care physicians or patients to obtain referrals
• Handle patient inquiries regarding insurance coverage and benefits
• Assist in explaining financial screening and application processes, collaborating with Financial Advocates
• Work closely with West Cancer Foundation for screening and approvals
• Assist patients who are uninsured in connecting with appropriate financial support teams
• Manage STAT add-on list daily
• Review and process scanned insurance cards and maintain accurate documentation
• Monitor group inbox tasks in EMR for eligibility and referral issues
• Communicate effectively with patients to explain coverage, copays, deductibles, out-of-pocket expenses, and referral requirements
• Collaborate with Front Desk, Medical Records, Business Office, Radiology, Nursing, and other internal teams to ensure accurate and timely insurance verification
• Address eligibility and referral issues raised by staff and leadership in a timely manner
• Perform all other duties as assigned
• Some travel to satellite offices may be required

Benefits

• No nights, weekends, or holidays.
• Comprehensive benefits package.