Patient Eligibility Specialist

Overview

This is a non-exempt on-site role, located at our New Providence CBO location and is part of Prism Vision Group.

Compensation Range
: $18-$35.50/hr (Dependent on Experience)

Key contributor to clinical and revenue cycle operations, a Patient Eligibility Specialist plays a pivotal role in managing patient information, verifying patient treatment eligibility through meticulous insurance processes, and supporting patient care through the accurate preparation of medical charts. This role demands a dynamic individual capable of navigating complex insurance systems and contributing positively to team dynamics.

ROLE AND RESPONSIBILITIES

• Insurance Verification:
  Confirm patient insurance details, including detailed benefits and referrals, to ensure eligibility and secure financial reimbursement ahead of service delivery.
• Appointment Coordination:
  Analyze patient information to verify the appropriateness of appointment types,employing analytical skills for optimal scheduling.
• Chart Management:
  Prepare and review electronic medical charts, understanding minimal clinical requirements to match treatments with diagnoses.
• Financial Clearance:
  Accurately gather and verify all patient demographic, financial, and insurance information, ensuring comprehensive financial clearance. This includes obtaining necessary referrals, authorizations, and pre-certifications to mitigate denials and secure reimbursement.
• Patient Communication:
  Inform patients/guarantors about their benefits, authorization needs, and out-of-pocket responsibilities, including co-pays, deductibles, and co- insurance.
• Prior Authorization:
  Efficiently manage prior authorization demands, including reviewing patient diagnoses, communicating with insurance carriers, and utilizing insurance portals for submission.
• Compliance and Communication:
  Maintain patient confidentiality, contribute positively to team dynamics, and engage in continuous professional development through meetings and seminars.
• Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity.
• Other duties as assigned.
• Aids with ad-hoc, special projects, as needed.

POSITION QUALIFICATIONS

Education:

High School Diploma or GED required.

Experience:

1+ years of experience and knowledge in medical services profession, insurance plans, revenue cycle, or a combination of all. Familiarity with Practice Management systems.

KNOWLEDGE/SKILLS/ABILITIES

• Accountability – Ability to accept responsibility and account for his/her actions and work performed. Willing to accept constructive feedback.
• Accuracy – Ability to perform work accurately and thoroughly with attention to all details of a project or task.
• Adaptability – Ability to adapt to and facilitate change in the workplace.
• Communication – Ability to communicate effectively with others using good listening skills.
• Empathetic – Ability to appreciate and be sensitive to the feelings of patients and co-workers.
• Initiative – Ability to make decisions and take actions to solve a problem or reach a goal. Desire to excel, attempting non-routine tasks.
• Judgment – Ability to make sound decisions using available information.
• Reliability – Can be relied upon to demonstrate reliability in attendance and punctuality.
• Team Player – The ability to work with others and independently for a common goal. Puts aside own individual needs to work toward the larger group objective and reinforces the contribution of others.
• Prior healthcare experience
• Insurance Knowledge:
  Familiarity with insurance referral and reimbursement criteria.
• Communication:
  Exceptional verbal and written communication skills.
• Analytical Proficiency:
  Strong critical thinking, analytical, and problem-solving abilities, coupled with…