Eligibility Specialist / Plano

Job Description

Job Description

Job Purpose

This position will be located in the Plano Office and will provide support services for all 15 locations.  The position will report directly to the Revenue Cycle Director.  The Eligibility Specialist is responsible for payer and patient account authorizations, predeterminations, insurance verifications that are obtained in a timely and decisive manner and answering routine and non-routine account inquiries. Follows standard procedures and pre-established guidelines to complete tasks.

Texas Retina Associates is Texas’ largest, most experienced ophthalmology practice focused specifically on the diagnosis, medical and surgical management of diseases of the retina and vitreous.  Our fellowshipped and specialty trained physicians care for the most complicated retina conditions such as ocular cancer and uveitis.  This physician owned medical group provides services at 15 locations throughout the DFW metroplex, Waco, Wichita Falls and Lubbock. 

Essential Duties

Verification of insurance, coordination of benefits and prior authorization as needed.

Work directly with insurance representatives to confirm all claims and submit successfully to ensure payments are being processed in a timely manner.

Work with co-workers to resolve insurance errors.

Contacts patients to verify patient demographics and insurance providers, updates information in systems, and documents conversations.

Answer patient insurance questions and resolve complaints.

Participate in the implementation of procedures to improve the quality of work being processed.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below represent the knowledge, skill and /or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Minimum Education and Experience

High School diploma or equivalent required.

Minimum two (2) years combined medical insurance authorization and verification experience required.

Demonstrate knowledge of state, federal, and third-party claims processing required.

Demonstrate knowledge of state & federal collections guidelines.

Experience with NextGen preferred.

Must successfully complete required training within 90 days of occupying position.

Skills and Specifications

Work under minimum supervision and demonstrate strong initiative.

Make independent decisions when circumstances warrant; make prompt and accurate judgments.

Excellent communication with physicians, patients and staff is required. 

Must be articulate in English speech, writing and understanding.

Strong ability to listen, answer all questions as simply as possible and act when needed to resolve issues.

Excellent organization skills; solid attention to detail to ensure accuracy of information

Proven analytical skills; recognize, evaluate, solve problems, and correct errors, and develop processes that eliminate redundancy

Use independent judgement to escalate issues to manager as necessary.

Must be willing to work under pressure.

Excellent Microsoft Office Suite skills including Excel, Word, Outlook and Access

Attend work as scheduled and/or required.

Complete all other duties as assigned.

Physical Requirements

Sedentary with prolonged sitting, talking and working at computer. 

Hear and use hands and fingers to operate and handle keyboards and controls

Occasionally required to walk, bend and reach with hands and arms

Must be able to lift up to occasionally lift, carry and/or move up to 25 pounds.

Specific vision abilities include close vision and the ability to adjust focus.