An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
Health Solutions West is the Western slope's largest behavioral health care organization, covering more than 23,000 square miles across 10 counties. With over 250 employees in Western Colorado, you would be joining a mighty team of support and administrative staff, case managers, clinicians, physicians, nurses, and others in our efforts to improve the health and wellbeing of our community.
Medical Dental Vision Paid time off accrual and generous leave policy 403(b) benefits with 6% company match What You'd Be Doing As the Insurance Verification & Authorization Specialist you would assist clients with their insurance options, coverage, and direct them to alternative resources in the community that are available to assist them, and reporting functions.
Responsibilities:
Under the supervision of the Insurance Verification & Authorization Supervisor and Director of RCM, the Insurance Verification & Authorization Specialist is responsible for the following: Verifying eligibility, ensuring all insurances are active and insurance information is correct for health benefits and updating the chart with correct information prior to scheduling clients. Request prior authorization for services prior to visits if needed. Assist clients with completing applications for Medicaid, other insurance benefits, outside assistance, and/or other community services. Ensure all appropriate forms are completed timely and accurately. Assist clients with sliding fee scale application. Provide financial counseling services to clients prior to treatment or when referred by other departments. Discuss patient financial obligations, access financial hardship and establish payment arrangements. Monitor overdue accounts and proactively collect outstanding balances in conjunction with the collection agency. Review accounts pending collection agency submissions. Provide exemplary customer service, demonstrating patience and understanding, while carrying out the company's payment policies. Maintain strict confidentiality of sensitive and protected information in accordance with HIPAA regulations. Other duties as assigned.
Physical requirements include the following:
Constantly remains in a stationary position the majority of the time Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer. Occasionally lift and carry items up to 15 pounds What We're Looking For—The Must-Haves High school diploma or equivalent required At least 3 years of relevant medical office experience and basic understanding of billing processes Practical knowledge of payer specific rules and regulations, including Medicaid and Medicare Excellent interpersonal and customer service skills Demonstrated experience to include counseling, analysis, collaborative teamwork, professional communications and interactions, advocacy, financial management, and customer service. Willingness to work collaboratively with multiple teams and tasks. Proficient in Windows-based computer programs and electronic charts, as well as basic office equipment Ability to multi-task and prioritize in a fast-paced setting Well-organized, self-motivated, and proficient time management Strong communication skills both verbally and in writing What We'd Like to See in You—The Nice-to-Haves Experience working in NextGen and MyAvatar electronic health record systems CAAS Certification Health Solutions expects all staff to Adapt to change in the workplace and use change as an opportunity for innovation and creativity. Take ownership of problems, brainstorm problem resolutions, and use sound judgment in selecting solutions to problems, and demonstrate consistent follow through. Possess the job knowledge and skills to perform the fundamental job functions and assume greater responsibility over time regarding the scope of work. Inspire and model collaborative teamwork; and Demonstrate accommodation, politeness, helpfulness, trust building, appropriate boundaries, and flexibility in customer service. Must already be authorized to work in the US; sponsorships not available.
