Eligibility Representative position Mon - Fri 9a-5:30pfor qualified individuals at Moses Scranton, Scranton , PA. in the Eligibility Screening Services Department. ESS is an Equal Opportunity Employer
Eligibility Representative position for qualified individuals at Moses Scranton, Scranton , PA. in the Eligibility Screening Services Department.
Job duties include:
Verifies detailed insurance benefits, medical necessity, and authorization/referral guidelines, consistently prioritizing and following the established verification processes.
Communicates outstanding documentation requests, required account follow-up, and payor issues to the appropriate facility contacts.
Responsible for maintaining performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met while maintaining effective communication with patients, physicians, medical office staff, and both internal and external co-workers.
Calculates the estimated patient financial responsibility via the estimation tool.
Notates all actions performed in the applicable host system(s) immediately.
Performs all other duties, as assigned or requested, while adhering to strict deadlines
screening referred self-pay patients for programs such as Medicare, Medicaid, Medicaid for nursing home placement, Crime Victims, vocational rehabilitation, QMB, SSI, and any/all other third party coverage including other available local, state, and federal programs in addition to the hospital's financial assistance program
providing point of service collections for self-pay patients, patients who have balances after insurance or Medicare payments, and patients that do not qualify for any programs/coverage.
at least 1 year of healthcare experience
proficiency in Microsoft Word and Excel
meet productivity standards ( there is a potential quarterly bonus structure in place for high performers )
comply with hospital policies
Bilingual in Spanish is preferred and additional compensation added
Prior experience in collections and knowledge of HIPAA,EMTALA, and PHI are a plus.
Community Health System