Insurance Eligibility Specialist

Position Summary

This position is responsible for conducting patient insurance verifications before patient visits. Must be highly skilled in verbal communication and be capable of high-volume workloads. The Patient Eligibility Specialist's primary focus is the accuracy and timeliness of patient insurance verification and data entry to ensure accurate collection of balances, co-payments, co-insurance, and deductibles for multiple locations in the organization.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Obtains patient eligibility and benefits via portal, electronic inquiries, and phone or interactive voice response (IVR) calls.

• Access multiple web portals to identify and verify eligibility and benefits for all patients with appointments, including the deductible and co-pay information prior to the appointment time.

• Completes all verifications for scheduled patients 72 hours before the visit.

• Add/Update insurance information including appropriate co-payments due in the organization's practice management system.

• If the patient's insurance is no longer valid, contact the patient for new information and educate the patient on the sliding discount program and what to bring in for qualification at the visit.

• Note pertinent information in the EMR regarding the patient's insurance and balances required for the check-in process.

• Understand all types of insurance that CCHS is contracted with specific policies regarding BHC and Dental visits; and restrictions.

• Understand specific policies regarding BHC and OTP visits; and restrictions.

• Follow up with patients on denied insurance verifications before the visit.

• Work closely with front desk staff to promptly collect all co-payments, and co-insurance amounts.

• Work closely with third-party navigators regarding self-pay patients.

• Work closely with the Director of Patient Accounts on insurance and eligibility issues, as they arise.

• Handle a high-volume workload, prioritize multiple demands, and organize with detail and accuracy.

• Answer inbound patient calls timely and address patient needs thoroughly.

• Maintain accurate and complete documentation of all contacts.

• Participate in staff meetings and other meetings as instructed.

• Performs other duties as required and assigned.

Minimum Qualifications (Education and Experience): High school diploma or equivalent. A minimum of one to two years of experience in insurance eligibility and benefits required. Associate degree in Healthcare Administration or Medical Office Administration preferred. EMR experience required.

Knowledge, Skills and Abilities (KSA's):

• Computer knowledge.

• Excellent customer service and communication skills.

• Ability to work as a team member.

• Manage multiple tasks simultaneously.

• Highly motivated and organized.

• Empathetic with patients' needs and concerns.

• Understanding of insurance plan types, medical terminology, and basic billing processes.

• Ability to navigate insurance websites.

• Ability to work independently and complete tasks within the expected timeframe.

• Attention to detail and ability to complete the job with minimal errors.

• Experience with Microsoft Word, Excel, and Outlook (preferred).

• Experience using Microsoft Teams (preferred)

Other Requirements:

• The person in this position works a professional workweek and the incumbent's flexibility in this work schedule is considered a condition of employment.

• Ability to travel locally and occasionally to health centers

• Train new hires on registration, insurance, and eligibility.

Supervision: N/A

Physical and Environmental Demands:

Work is performed in an office and clinic setting; standing, walking with intermittent sitting; reaching for and using writing instruments and keyboard; reading reports and other written materials; extensive use of telephone and oral communication with the public and coworkers; stoops; bends; kneels; reaches for; picks up; and pushes or pulls; ability to lift to 30 pounds.