The Role
Verifies patient insurance eligibility, coverage, specialty-service requirements, and insurance details before appointments. Updates patient insurance records, handles Third Party Liability updates, imports documentation into charts, and contacts insurers as needed. Communicates billing issues, coordinates with Patient Service Representatives, and completes eligibility tasks accurately and promptly while supporting quality improvement initiatives.
Summary Generated by Built In
As an Eligibility Specialist, you will be verifying insurance eligibility and performing schedule preparation to ensure the accuracy of insurance prior to patients’ appointments.
JOB RESPONSIBILITIES:
- Verify Eligibility.
- Communicate issues to the billing department as they arise.
- Verify if a patient is due for a specialty service prior to their appointment.
- Check all insurance details to ensure accuracy of insurance.
- Review and update patients’ insurance the day or day(s) prior to their appointment.
- Import necessary documentation into the patients’ charts.
- Call insurance companies to verify insurance coverage as needed.
- Work closely with Patient Service Reps to collect necessary documentation at the clinic.
- Work on Third Party Liability (TPL) updates.
- Works Tasks in a Timely manner.
- All HealthLinc staff is committed to engage in quality improvement initiatives that align with and support Patient-Centered Medical Home (PCMH).
- Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
REQUIRED QUALIFICATIONS:
Education/Training
- High school diploma or equivalent
Experience
- Minimum one year experience working with eligibility
- Patient Service Representative, Billing, Intake Coordinator or Outreach experience highly preferred
- Experience with interpreting Explanation of Benefits highly preferred
- Experience with medical terminology highly preferred
Skills/Job Requirement
- Working knowledge of Intergy, FSSA, and insurance portals
- Customer service skills
- Written and verbal communication skills
- Proven ability to work in a team environment, as well as independently
- Ability to remain flexible and teachable
- Strong organizational and time management skills
Technology Skills
- Operate a multi-line phone system and other office equipment including printers, fax machines, etc.
- Basic software skills (Microsoft Office, EHR, online sources, etc.)
Skills Required
- High school diploma or equivalent
- Minimum one year of experience working with eligibility
- Patient Service Representative, billing, intake coordinator, or outreach experience
- Experience interpreting Explanation of Benefits
- Experience with medical terminology
- Working knowledge of Intergy, FSSA, and insurance portals
- Customer service skills
- Written and verbal communication skills
- Ability to work in a team environment and independently
- Ability to remain flexible and teachable
- Strong organizational and time management skills
- Ability to operate a multi-line phone system and office equipment
- Basic software skills, including Microsoft Office, EHR systems, and online sources
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The Company
What We Do
HealthLinc is a not-for-profit Federally Qualified Health Center providing comprehensive primary medical, dental, optometry, and behavioral health services to all individuals, regardless of their ability to pay, with a mission to create healthy communities.
