Eligibility Specialist II - RCO Financial Clearance

EDUCATION & EXPERIENCE:

Minimum Qualifications:

Three years of financial experience or two years patient accounts experience.

JOB SUMMARY:

Performs follow-up activities on outstanding hospital and physician accounts and assists patients in the Medicaid/SSI application process. Takes necessary action to ensure timely and appropriate reimbursement and/or account resolution.

ESSENTIAL JOB FUNCTIONS:

* Assists patients in the Medicaid/SSI application process, converting unfunded patients into funded patients

* Acts as a liaison between the patient and various agencies such the Health and Human Services Commission (HHSC), the Social Security Administration (SSA), etc

* Coordinates and processes various forms/paperwork necessary for Medicaid/SSI reimbursement, UTMB admissions, and/or other related forms

* Maintains open and professional communication with customers, colleagues and vendors

* Updates information and enters appropriate codes in the patient accounting system

* Maintains comprehensive knowledge of the work unit assigned

* Prepares and maintains reports related to job duties

* Updates and develops departmental policies and procedures

* Assists in the training and mentoring of new employees

* Adheres to established policies and procedures

* Adheres to internal controls and reporting structure

* Performs detailed follow-up activities on assigned accounts according to procedures

* Resolves outstanding AR accounts at a defined level of productivity

* Validates accuracy of payments and/or adjustments on accounts

* Processes account adjustments according to policy and procedures

* Researches and resolves credit balance accounts

* Identifies and/or prepares and processes account refunds

* Responds to daily correspondence

* Verifies eligibility for coverage with any commercial insurance, government or charity programs

* Performs account reviews, audits, and/or appeals

* Performs quality assurance reviews

Marginal or Periodic Functions:

* Successfully completes competency based training and testing on an annual basis

* Prioritizes and completes all work in an accurate, effective and efficient manner

* Participates in team meetings/activities and supports the philosophy and goals of the team and department

* Participates in special projects/assignments

* Reads all announcements and relevant communications relating to job duties

* Performs related duties as required.

WORKING ENVIRONMENT/EQUIPMENT:

* Standard hospital, clinical, laboratory and/or office environments.

* Standard office equipment.

SALARY RANGE:

Actual salary commensurate with experience.

WORK SCHEDULE:

On-site, full-time, 40 hours per week.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

Compensation