Eligibility Specialist

Eligibility Specialist - Dialysis

Full Time - Remote

Summary

Innovative Renal Care is seeking a detail-oriented Eligibility Specialist to manage insurance processing and benefit verification for our dialysis clinics. In this fully remote role, you will serve as a critical link between patients, clinic staff, and insurance providers to ensure seamless access to care.

Key Responsibilities

• Perform comprehensive benefit verifications via phone or online tools to confirm patient coverage and network status specific to the rendering clinic.
• Maintain 100% accuracy of patient insurance records within the billing system, proactively initiating updates as coverage changes occur.
• Serve as the primary internal contact for complex insurance setups and coordination of benefits (COB), ensuring strict compliance with Medicare and CMS rules.
• Partner closely with clinic staff, collections, and insurance educators to ensure timely verification and a seamless setup for all insurance changes.
• Manage region- and clinic-specific reports to track new or inactive policies, preventing billing delays or lapses in life-sustaining patient coverage.
• Communicate proactively with patients and clinic teams regarding the loss of insurance benefits to prevent disruptions in dialysis treatment.
• Initiate authorization requests as required by specific insurance providers and clinic network status.

Education & Experience

• Bachelor's degree in Business, Healthcare Administration, or a related field is preferred. An equivalent combination of education and significant relevant professional experience will be considered.
• Demonstrated experience in medical billing, insurance verification, or patient access.
• Exceptional communication skills and a proven ability to meet strict deadlines while maintaining high standards of data accuracy.
• Prior exposure to Medicare Coordination of Benefits (COB) and the 30-month coordination period for End-Stage Renal Disease (ESRD) preferred.
• Experience using insurance portals and clearinghouses for digital benefit verification preferred.
• Experience working in a high-volume Revenue Cycle Management (RCM) environment or a centralized billing office (CBO) preferred.
• Proficiency in Spanish is preferred but not required.
• Proficiency in Microsoft Office Suite, with a strong emphasis on Excel, Word, and Outlook.

At Innovative Renal Care (IRC), our comprehensive benefits program is a key component of our total compensation package. It includes a 401(k) match, healthcare coverage, and a broad range of other benefits that compare favorably within our industry and marketplace. Learn more atIRC Benefits and Perks

About Innovative Renal Care

We are one of the largest dialysis service providers in the U.S., partnering with local physicians to deliver high-quality care to patients with ESRD and other kidney conditions. Our mission is to be the trusted experts and preferred partners for patients, physicians, and healthcare providers by delivering best-in-class care, service, and solutions.

Our Values: I CARE

Integrity & Innovation - Earn trust by keeping promises and embracing new solutions.

Compassion - Treat patients, families, and colleagues with respect and empathy.

Accountability - Take ownership and recognize the contributions of others.

Results-Driven - Strive for excellence and exceed expectations.

Everyone Counts - Foster diversity, equity, teamwork, and collaboration.

Why Join IRC?

• Career Growth - Be part of a values-driven team making a meaningful impact.
• Competitive Compensation - Salaries continually benchmarked against market and trends.
• Enhanced PTO - Your most recent dialysis experience counts toward PTO accrual.
• Team Culture - Thrive in a supportive environment that values innovation, accountability, and compassion.

Innovative Renal Care is an equal opportunity and a drug free workplace .All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, sexual orientation, gender identity, national origins, citizenship, disability or protected veteran status.All applicants will be subject to a drug screening and background check upon acceptance of an offer.

*IRC will only contact you from View email address on click.appcast.io or team members with an @innovativerenal.com email address. Please be cautious and aware of spam or fraudulent emails soliciting personal or banking information. IRC will not request this information via email.

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