[Hiring] Eligibility Specialist @ce221109-aaa3-47b2-aead-38a00b716f6f

Role Description

Optim Orthopedics is seeking a full time Eligibility Specialist/Remote.

• Reviews clinic schedules 48 hours in advance of appointment for designated locations and checks all eligibility and benefits to ensure patient insurance is active.
• Will be required to contact patient if there is an issue with their insurance in advance of the appointment.
• Updates copay information in Athena and provides notes in the patient account for the front desk regarding co-insurance, deductibles due and collections of any balances due prior to patient's appointment.
• Monitors eligibility bucket in EMR for upcoming appointments.
• Reviews the patient's insurance for eligibility and benefits.
• Responsible for ongoing daily monitoring of EBT email group to assist Patient Access Coordinators with eligibility issues identified at the time of making the appointments.
• Responsible for verifying that authorizations are obtained and attached to the appropriate appointment at the time of the visit to ensure claim is submitted correctly and accurately.
• May assist Patient Account Coordinator as needed in setting up payment plans to help patients manage payment of bills.
• May assist in identifying and communicate any trends, denial issues or irregularity impacting resolution of patient accounts or daily production workflow to supervisor and other team members and recommend resolution.
• Must have a comprehensive understanding and knowledge of the insurance claim process, EOB and patient statement to assist patients as needed with questions.
• Forwards any billing issues identified to the appropriate staff to assist patients with resolution.
• Maintains up-to-date knowledge of third party billing and reimbursement, clinic's financial policies and industry knowledge.
• Must maintain accuracy in demographic and data entry in the EMR system.
• Uses electronic systems (email, Practice Management System and EMR) for communication to other staff members to have an accurate detail account in the patient record.
• Maintains professional and respectful documentation at all times in the patient record.
• Responds to patient calls timely and professional and documents appropriately in the patient chart.
• Completes annual compliance and regulatory requirements as applicable.
• Follows all work processes, procedures while maintaining compliance to the organizations rules and regulations.
• Protects and keeps all patient information confidential following all HIPAA, state and federal laws.
• Upholds and promotes patient safety and quality.
• Accepts ownership for all tasks and responsibilities while improving the company's reputation.
• Escalates any problems to the Manager or Supervisor as appropriate.
• Demonstrates and encourages team behavior and exceptional patient/guest experiences.
• May be required to serve as back up as needed for other Front Office positions for check in or check out.
• Other duties may be assigned.

Benefits

• Competitive Pay
• Company Benefits
• Paid Time Off
• Holiday Pay
• 401K Plan

Company Description