Insurance Eligibility Specialist

Insurance Eligibility Specialist Beale Personnel, Inc. - 5.0 Tucson, AZ Job Details Full-time $17 - $19 an hour 1 day ago Benefits Health insurance Dental insurance Paid time off Vision insurance 401(k) matching Qualifications Revenue cycle management Medicare Managed care Electronic health records (EHR) management Customer inquiry handling High school diploma or

GED ICD-10

Organizational skills Associate's degree Full Job Description A comprehensive general Ophthalmology practice in Tucson, AZ is seeking an Insurance Eligibility Specialist. The Insurance Eligibility Specialist is responsible for verifying insurance coverage, determining patient eligibility for services, and ensuring that authorizations are in place before services are rendered. This role plays a key part in the revenue cycle by minimizing claim denials due to eligibility issues and ensuring accurate billing information.

Key Responsibilities:

• Runs Eligibility Worklist to determine which accounts need insurance coverage verified and eligibility for patients prior to scheduled appointments, admissions, or procedures.
• Requirement is to be 2 weeks out in schedule and 2 doctors' will be assigned.
• Communicates with patients to inform and collect OOP-Deductibles-Copay- Co-Insurance amounts.
• Inform patient about OON benefits
• PCP Referrals - Identifies and Follows Up to make sure we have referral prior to appointment (enter ALERT) Referral Required. Update MDI side with notes and upload referral to Nextech under documents and MDI side. In General Notes under MDI make sure to enter Referral Obtained. Maintain Referral Log by Patient Name, Appointment date and time.
• Date requested referral
• Sent Communication to Dr if need be.
• Self-Pay Patients- Let them know approximately how much the OV will be (other cost will discuss with PA)
• Use the Price Cost Estimator if applicable
• Documents information in Nextech under notes
• Accurately enters and updates Insurance information into PM system.
• Verifies that the necessary authorizations or referrals was obtained.
• Document Check Eligibility (Initials) under Appointment history for fee ticket
• Goes into MDI and enters Eligibility Information
• Add-On's will verify and update Eligibility
• Work closely with schedulers, authorization, billing staff, and clinical teams to ensure accurate and timely patient care and billing.
• If patient is in-house will speak with them regarding any insurance issues…
• Respond to internal and external inquiries related to insurance coverage and eligibility.
• Follow up with insurance companies to confirm continued coverage or resolve discrepancies.
• Stay up to date with payer requirements, plan changes, and industry regulations.
• Assist in resolving claim denials related to eligibility.
• Designated A&E Fax number
• Working Hours 8:00am-500pm 1 hour lunch

Required Qualifications:

• High school diploma or equivalent; associate degree in healthcare administration or related field preferred.
• 1-2 years of experience in healthcare insurance verification or billing.
• Familiarity with major insurance providers, government programs (Medicare/Medicaid), and managed care plans.
• Proficiency in EMR systems and insurance portals.
• Strong attention to detail and organizational skills.
• Excellent communication and customer service skills.
• Ability to work independently and as part of a team in a fast-paced environment.

Preferred Qualifications:

• Knowledge of

CPT/ICD-10

coding and medical billing practices.

Pay:

$17.00 - $19.00 per hour

Benefits:

401(k) matching Dental insurance Health insurance Paid time off Vision insurance

Experience:

Insurance eligibility coverage: 1 year (Required) ICD 10 coding: 1 year (Required)

Work Location:

In person