Eligibility Specialist at None

GENERAL SUMMARY

Performs pre-verification of insurance information for patients and resolution of problems prior to patient visit to ensure a clean billing process. Follows up on accounts that require further evaluation and updated insurance information. Works with others in a team environment.

DUTIES & RESPONSIBILITIES

• Working knowledge of Managed Care, Commercial Insurance, Medicare, Medicaid and all Medicare and Medicaid products.
• Work with all insurance companies to confirm eligibility and benefit coverage.
• Insures insurance coverage by phone or online as required to obtain and enter accurate benefit information to positively impact insurance processing and minimize rejections.
• Effectively research and resolve all insurance issues prior to the patient visit.
• Update any changes of insurance information within the system.
• Contact patient by phone, text or email regarding information required to verify eligibility and coverage.
• Maintain work operations and quality by following standards, policies and procedures; escalate compliance issues to supervisor.
• Provide excellent and professional customer service to internal and external customers.
• Function as contributing team member while meeting deadlines and productivity standards.
• The eligibility specialist may temporarily perform other duties as assigned to maintain operations and services.

EDUCATION & EXPERIENCE:

• Graduation from an accredited High School or equivalent
• A minimum of one (1) year in insurance verification

KNOWLEDGE, SKILLS & ABILITIES

• Ability to understand written and verbal instruction, neatness and efficiency.
• Must be able to communicate well and work effectively with patients, insurance companies and staff. 
• Proficiency with Windows, MS Word, and Excel 
• Excellent customer service skills and abilities
• High level of professionalism 
• Meticulous attention to detail 
• Knowledge of insurance, especially Medicare and Medicaid.
• Strong ability to speak effectively, present information, and respond to questions from manager, physician, or patients 
• Strong ability to perform and complete projects in a timely manner with minimal supervision
• Ability to define problems, collect data, establish facts, and draw valid conclusions 
• Perform a variety of administrative duties including but not limited to: answering phones; faxing and filing of confidential documents; and basic Internet and email utilization