The Eligibility Specialist is responsible for reviewing patients’ insurance to verify eligibility for qualifying coverage prior to the patient’s visit and updating insurance information in patient profiles. This role supports management with oversight of patient eligibility and patient application processes while serving as a liaison between the client and other departments.
Key duties include:
- Determine whether re-authorization is needed for a new order
- Verify insurance eligibility
- Contact insurance companies to obtain policy and payment benefit information for patients
- Explain covered amounts under benefit plans in clear, easy-to-understand language
- Maintain strong medical terminology knowledge to better understand procedures
- Protect sensitive data, including patient medical records and payment card information
- Sign payment approvals for accepted claims
- Update patient and insurance data regularly and accurately in the company system
- Handle billing-related activities focused on medical specialties
- Review claims, records, and procedures to approve coverage
- Check documentation for appropriate coding, identify errors, and make revisions
- Verify proper insurance coverage prior to procedures or appointment scheduling
- Create and maintain accurate, confidential patient files in accordance with regulatory requirements
- Update patient financial information to support accurate recordkeeping
- Perform additional duties as assigned
Requirements & Qualifications
- High school diploma or equivalent
- Associate’s degree in a related field and/or Medical Billing Certificate from an accredited school preferred
- Minimum 1 year of experience in medical billing, medical insurance, and/or customer service
- Working knowledge of medical terminology
- Ability to work independently with strong critical thinking and time management skills
- Typing speed of 45 words per minute
- Strong computer skills, including proficiency in Microsoft Office
- Excellent customer service and verbal/written communication skills
- Strong interpersonal skills and ability to work well with others
- Ability to adapt to changing situations and a stressful environment
- Ability to perform tasks involving physical activity as required by the role
Location
Riverside, California, US
Employment Type
Full-time
Experience Level
Entry Level
Remote work allowed
No
Posted
1 month ago
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