Insurance Eligibility Specialist

Insurance Eligibility Specialist (MEM
009770)

Location:

Fountain Valley, CA

Status:
Full-time (8hr)

Shift: Days

Pay Range: $22.89/hr - $33.18/hr

Memorial Care is a nonprofit integrated health system that includes four leading hospitals, award‑winning medical groups, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient‑centric, affordable, and high‑quality healthcare; your personal contributions are integral to our recognition as a market leader and innovator in value‑based care models.

The Insurance Eligibility Specialist is responsible for timely and accurate verification of medical insurance benefits for both admission and pre‑admission visits. The Specialist will obtain current eligibility, verify benefit coverage, and ensure accurate information (pre‑certification, authorizations & tracking numbers) is documented into the registration system to secure reimbursement. They must be knowledgeable with insurance contracts, able to work from work queues, assist with training new staff, and multi‑task while prioritizing essential job functions.

Effective relationships with coworkers, nurses, physicians, and other hospital staff are essential to workflow effectiveness.

• TIME AND ATTENDANCE: Adhere to the MHS Time and Attendance policy, clock in and out accurately with minimal manual requests, and sign off on MTM by the end of each pay period.
• PATIENT IDENTIFICATION: Avoid HIPAA violations by accurately entering patient information, using two patient identifiers to prevent errors such as incorrect PCP, guarantor, IPA, health plan, subscriber, and W/C details.
• DOCUMENTATION AND DATA ENTRY: Input accurate documentation into the registration system to secure reimbursement. Ensure all verification documentation is complete and scanned into EPIC timely. Enter notes into referral or auth/cert workflow following the admitting department Standard Work regarding patient benefits, out‑of‑pocket lifetime max, and effective dates of insurance eligibility.
• CUSTOMER SERVICE/PROFESSIONALISM: Interact positively and constructively, delivering excellent customer service to patients, visitors, office staff and hospital staff to ensure workflow effectiveness. Maintain an effective and professional working relationship with co‑workers and others.
• ELIGIBILITY VERIFICATION: Perform insurance eligibility timely and accurately. Have expertise in EPIC, OnBase, RTE, contracts, and websites to ensure accurate and efficient reimbursement.
• ATTENDANCE OF MEETINGS AND PROFESSIONAL DEVELOPMENT: Participate in department‑specific performance improvement plans (e.g., education/training, staff meetings, projects, Press Ganey employee engagement survey, Simply Better and Service excellence).
• EPIC WORK QUEUE MONITORING/PRODUCTIVITY: Monitor and manage assigned EPIC work queues, ensuring immediate bill release. Meet the department’s daily productivity requirements to maximize productivity by meeting weekly goals.
• PATIENT ESTIMATES AND OTC CASH COLLECTIONS: Create patient estimates accurately and timely. Notify patients of estimate amount via phone and mailed letter. Compute patient estimates and advise patients of their financial responsibility, including deposits, co‑pays, deductibles, estimates, and co‑insurance. Collect out‑of‑pocket financial liabilities prior to scheduled services.
• INSURANCE PLAN CODE SELECTION: Obtain and assign the correct insurance plan code and IPA codes with minimal errors.
• WORKFLOW MANAGEMENT: Possess the ability to multitask and perform multiple duties simultaneously due to high patient volumes.
• Other duties as assigned.

• Experience: Minimum of 2 years in admitting/registration/insurance verification or equivalent healthcare experience preferred.
• Knowledge: Knowledge of insurance and payors.
• Communication: Ability to communicate effectively verbally and written.
• Customer Service & Computer
  
  Skills:
  
  Strong customer service and computer skills required.
• Education: High school diploma or GED preferred; medical terminology course preferred.

Health and wellness are our passion at Memorial Care, including high‑quality health insurance plan options for employees and their dependents. Additional compensation may be available for this role, including shift differentials, extra shift incentives, and bonus opportunities. For more information, see Memorial Care Benefits.