Eligibility Representative/Insurance Verification Specialist - Carlsbad, NM

Job Description

Schedule: Tuesday

• Saturday 8:30am

• 5:00pm

Essential Job Duties

• Answer phone calls in a professional and courteous manner, taking appropriate action

• Screen patients using a positive, respectful, and courteous tone.

• Utilize screening and determination forms to assist self-pay patients in applying for possible eligible programs and financial aid.

• Assist patients in obtaining all papers and proof necessary so that the case can be reviewed by appropriate case worker(s).

• Assist patients in completion of all applications. This may include assisting the patient with the required reading, writing and/or explanation of the questions on the application.

• Maintain a high level of accuracy on all forms.

• Facilitate payment through established ESS Collection protocols.

• Contact the patient prior to and after the appointment to ensure that the appointments are kept.

• Assist to secure transportation for patients to attend application appointments as necessary.

• Conduct visits to patients' home and local agencies to conduct screening interviews, complete applications, gather necessary verification documents, drop off applications, and check status of applications.

• Work closely with governmental agencies to complete the application processes for patients.

• Enter correct patient data into the computer terminals. Review and follow-up on patient accounts in a timely manner. Maintain and update all patient accounts to reflect current information in a timely manner.

• Skip trace accounts as needed.

• Monitor accounts to ensure patient payments are received and applied to patient accounts by facility cashiers.

• Report work in progress, addressing any backlogs, and providing a course of resolution to the Site Manager and/ or Client Services Manager/Director.

• Comply with Hospital policy and procedures and pertinent laws or regulations

• Observe professional ethics in maintaining confidential information acquired concerning the personal, financial, medical, or employment status of patients and their families.

• Follow accepted safety practices for patients and hospitals, report safety hazards and initiate appropriate action, and participate in safety instructional programs.

• Must be able to pass and maintain Certification for Application Counseling for states necessary for position.

• Other duties as assigned

Qualifications:

• High school diploma or equivalent required

• 1 year of experience in customer service / healthcare business office / or social services required

• Spanish preferred

• Customer facing experience required

• Working knowledge of Medicare, Medicaid, Medicaid for Nursing Home Placement, Crime Victims, Vocational Rehabilitation, QMB, SSI and any/all other third party coverage and other available local, state and federal programs preferred

• Relevant experience in lieu of degree, preferably in a hospital business office/admissions departments, or an eligibility