Eligibility Referral Specialist

Eligibility Referral Specialist

Location: Shirley, NY

Hours: 5/8.5 Hour Shifts; Monday-Friday

Organization: New York Cancer and Blood Specialists (NYCBS)

In This Role, You Will:

• Verify insurance benefits including primary, secondary, and tertiary. Obtain all pertinent information of out of pocket, co-insurance, deductible, co-pay, and if referrals / authorization are required for services.
• Update systems (both Centricity and OncoEMR) of any insurance changes that are made. Verify newly entered benefits into practice management system. Work with front staff to obtain new insurance cards and demographics every 3 months.
• Obtain referrals for office visits, labs, radiology, chemotherapy, radiation therapy, or any other services requested by the physician / office.
• Run daily business office activity report to work the Referral required and Insurance Issue statuses. This report will be run several times daily. All patients must be approved by end of day. Any patients that do not have a completed status by 4pm EST must be reviewed with manager to determine if appointment should be rescheduled.
• Work daily Visit Owner: NYCS Eligibility (Commercial) & NYCS Eligibility (Commercial) Pending Response). All tickets must be touched and/or worked daily. Appropriate visit descriptions are required to be listed on the ticket (s), correspondence (corr) notes added, and follow-up performed daily / in a timely manner.
• Work tickets daily in Centricity in the Hold status that are listed as a Query for referrals by Fedora to attach referrals or obtain referral retroactively before billing.
• Review schedule in advance for Physical Therapy appointments and enter verified benefits for PT services into patient's medical record chart.
• Coordination of Benefit (COB) letters are to be mailed to patients when phone contact (3x) has been unsuccessful. Sent letter must be documented in the correspondence (corr) notes of the tickets that are applicable.
• Answer calls from insurance companies, patients, and office staff on questions for claims, patient balance, or insurance/referral issues.
• Review and explain patient's statements and their financial responsibility. Work account as necessary and/or set up a signed payment plan with the patient where applicable.
• Refer to Financial Counselor if patient balance is for treatment with drugs and possible need of patient assistance / financial relief.
• Work closely with third party vendor Fedora to ensure referral/authorizations are in place and insurance benefits are accurate.
• Obtain referrals / authorizations for any add on treatment / same day.
• Maintain and ensure the confidentiality of all patient and employee information at all times.
• An eligibility referral specialist will be expected to work when given sufficient notice of required overtime.

We Require:

• High school or GED required.
• Experience working in the healthcare field, preferably in a clinical setting or business office.
• Experience in insurance requirements and medical terminology ICD-10 and CPT coding.
• Experience in billing practice management systems, electronic medical record systems, Microsoft Word, and Microsoft Excel.
• Excellent verbal and communication skills between co-workers, physicians, management staff, patients, insurances, outside programs.
• Ability to multitask, problem solve, utilize basic math skills and follow complex instructions.
• Must have ability to converse in a calm and friendly manner.
• Able to relate and comfort patients during a difficult time.

What We Offer:

• Starting Pay: $26/hr
• Benefits: Health Insurance on day 1, Dental, Vision, Life Insurance, Short- and Long-term disability, 401k Plan, PTO, 8 paid holidays (2 floating)

Join us at NYCBS, where we are making strides in healthcare through innovative and compassionate care.