Patient Eligibility Specialist

Patient Eligibility Specialist

This is a non-exempt on-site role, located at our New Providence CBO location and is part of Prism Vision Group.

Compensation Range: $18-$35.50/hr (Dependent on Experience)

Key contributor to clinical and revenue cycle operations, a Patient Eligibility Specialist plays a pivotal role in managing patient information, verifying patient treatment eligibility through meticulous insurance processes, and supporting patient care through the accurate preparation of medical charts. This role demands a dynamic individual capable of navigating complex insurance systems and contributing positively to team dynamics.

Role and Responsibilities

• Insurance Verification: Confirm patient insurance details, including detailed benefits and referrals, to ensure eligibility and secure financial reimbursement ahead of service delivery.
• Appointment Coordination: Analyze patient information to verify the appropriateness of appointment types, employing analytical skills for optimal scheduling.
• Chart Management: Prepare and review electronic medical charts, understanding minimal clinical requirements to match treatments with diagnoses.
• Financial Clearance: Accurately gather and verify all patient demographic, financial, and insurance information, ensuring comprehensive financial clearance. This includes obtaining necessary referrals, authorizations, and pre-certifications to mitigate denials and secure reimbursement.
• Patient Communication: Inform patients/guarantors about their benefits, authorization needs, and out-of-pocket responsibilities, including co-pays, deductibles, and co-insurance.
• Prior Authorization: Efficiently manage prior authorization demands, including reviewing patient diagnoses, communicating with insurance carriers, and utilizing insurance portals for submission.
• Compliance and Communication: Maintain patient confidentiality, contribute positively to team dynamics, and engage in continuous professional development through meetings and seminars.
• Maintain a high level of confidentiality regarding legal matters, privacy issues, and data integrity.
• Other duties as assigned. Aids with ad-hoc, special projects, as needed.

Position Qualifications

Education: High School Diploma or GED required. Experience: 1+ years of experience and knowledge in medical services profession, insurance plans, revenue cycle, or a combination of all. Familiarity with Practice Management systems.

Knowledge/Skills/Abilities

Accountability Ability to accept responsibility and account for his/her actions and work performed. Willing to accept constructive feedback.

Accuracy Ability to perform work accurately and thoroughly with attention to all details of a project or task.

Adaptability Ability to adapt to and facilitate change in the workplace.

Communication Ability to communicate effectively with others using good listening skills.

Empathetic Ability to appreciate and be sensitive to the feelings of patients and co-workers.

Initiative Ability to make decisions and take actions to solve a problem or reach a goal. Desire to excel, attempting non-routine tasks.

Judgment Ability to make sound decisions using available information.

Reliability Can be relied upon to demonstrate reliability in attendance and punctuality.

Team Player The ability to work with others and independently for a common goal. Puts aside own individual needs to work toward the larger group objective and reinforces the contribution of others.

Prior healthcare experience

Insurance Knowledge: Familiarity with insurance referral and reimbursement criteria.

Communication: Exceptional verbal and written communication skills.

Analytical Proficiency: Strong critical thinking, analytical, and problem-solving abilities, coupled with excellent patient care orientation.

Excellent interpersonal skills and ability to work effectively with physicians, co-workers, other departments and patients of all ages, and from across a broad range of cultural and social economic backgrounds.

Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in accordance with established policies and HIPAA regulations.

Demeanor: Personable, outgoing, and friendly, fostering positive interactions and relationships.

Work Ethic: Demonstrates flexibility and adaptability, capable of thriving independently and as an integral part of a team in dynamic environments.

Self-Management: Ability to work independently in a fast-paced environment, maintaining professionalism and confidentiality in line with HIPAA regulations.

Technical Skills: High proficiency in Microsoft Office Suite, especially Excel, and the ability to navigate and master various electronic systems.

Computer Proficiency, Microsoft Office to include Word, Excel, Power Point

Work Environment

An office environment with a controlled atmosphere.