Eligibility Specialist I

WHY JOIN FCS At Florida Cancer Specialists & Research Institute, we believe our people are our strength and we invest in them. In addition to having a positive impact on the people and communities we serve, associates benefit from significant professional opportunities, career advancement, training and competitive wages. Offering competitive salaries and comprehensive benefits packages to include tuition reimbursement, 401-K match, pet and legal insurance. Location Nine Mile A LITTLE BIT ABOUT FCS A LITTLE BIT ABOUT FCS Since 1984, Florida Cancer Specialists & Research Institute & Research Institute (FCS) has built a national reputation for excellence. With over 250 physicians, 220 nurse practitioners and physician assistants and nearly 100 locations in our network. Utilizing innovative clinical research, cutting‑edge technologies, and advanced treatments, we are committed to providing world‑class cancer care. We are recognized by the American Society of Clinical Oncology (ASCO) with a national Clinical Trials Participation Award, FCS offers patients access to more clinical trials than any private oncology practice in Florida. Our patients have access to ground‑breaking therapies, in a community setting, and may participate in national clinical research studies of drugs and treatment protocols. In the past five years, the majority of new cancer drugs approved for use in the U.S. were studied in clinical trials with FCS participation prior to approval. Through our partnership with Sarah Cannon, we are one of the largest clinical research organizations in the United States. Often, FCS leads the nation in initiating research studies and offering ground‑breaking new therapies to patients. Come join us today! SCOPE Under direct supervision, is responsible for the successful resubmission of invoices to the responsible party. Analyzes and resolves eligibility variances via web research and/or direct contact with patients. Coordinates the activities for the acquisition of referrals and retro‑authorizations, where applicable. Follows standard procedures and pre‑established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology’s Shared Values. ESSENTIAL DUTIES AND RESPONSIBILITIES Researches and obtain accurate and current insurance coverage information, makes corresponding corrections in the PMS. May evaluate benefits and eligibility to assess patient financial responsibility. May coordinate referral from primary care clinic to ensure appropriate authorizations are secured and entered into the PMS. Identifies uninsured patients and refers to patient benefit representative for coordination of payment. Communicates system issues and/or payor trends lead or supervisor. May answer questions and resolve complaints. Documents conversations with payors in the PMS. Contacts and follows up with clinic or any missing or incomplete documentation. Works TES Edits. Researches and responds to routine account inquiries and takes appropriate action; escalates non‑routine issues. Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regard to patient’s records and collections. Other duties as requested or assigned. MINIMAL QUALIFICATIONS High school diploma or equivalent required. Position is entry level and requires zero (0) to two (2) years with front desk, registrations, healthcare benefits or equivalent experience. Proficiency with computer systems and Microsoft Office (Word and Excel) required. COMPETENCIES Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; accesses and uses other expert resources when appropriate. Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility. Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty. Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them. Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye‑hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range. WORK ENVIRONMENT The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment. Work will involve in‑person interaction with co‑workers and management and/or clients. Work may require minimal travel by automobile to office sites. SCREENINGS – Background, drug, and nicotine screens Safeguarding our patients and each other is an important part of how we deliver the best care possible to the communities we serve. All offers of employment at Florida Cancer Specialists & Research Institute are contingent upon clear results of a thorough background screening. Additionally, as a condition of employment, FCS requires all new hires to receive various vaccinations, including the influenza vaccine, barring an approved exemption. In addition, FCS is a drug‑free workplace, and all new hires will be subject to drug/ nicotine testing. Medical Marijuana cards are not recognized. EEO Florida Cancer Specialists & Research Institute (FCS) is committed to helping individuals with disabilities to participate in the workforce and ensure equal opportunity to compete for jobs. FCS is an EEO/Affirmative Action Employer and does not discriminate on the basis of age, race, color, religion, gender, sexual orientation, gender identity, gender expression, national origin, protected veteran status, disability or any other legally protected status. At FCS, we believe the diversity, talent, skills and expertise of our people are our greatest assets, and we strive to provide a workplace where team members can thrive and grow. Benefits At FCS our mission is to provide top‑ranked care to those we serve, and investing in our team is a big part of that commitment. Here’s a brief overview of some of the core benefits we provide for our team members. Medical and Prescription Drug Coverage Vision & Dental Insurance Employee Assistance Program (EAP) Health Savings Account (HSA) & Flexible Spending Accounts Paid Time Off (PTO) 401(k) Retirement Plan Life Insurance Tuition Reimbursement Disability Insurance Accident Insurance Critical Illness Hospital Indemnity Pet Insurance Identity Theft Legal Insurance Workplace Policy In support of this belief, Florida Cancer Specialists & Research Institute is a smoke‑free workplace. Being a smoke‑free workplace means smoking is not permitted on any FCS Campus or Property; Employees may not smell of smoke while at work, FCS does not provide smoke breaks and there are no designated smoking areas on FCS Campus or Property. Medical Marijuana cards are not recognized. #J-18808-Ljbffr Florida Cancer Specialists & Research Institute