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.
Paid Holidays Tenure Bonuses Profit Sharing Continuing Education Opportunities Summary This position requires knowledge of insurance eligibility veri?cation processes, incoming insurance referral procedures, and familiarity with medical office work?ows. The role is responsible for verifying patients' insurance coverage and obtaining referrals as required for services. The position requires strong customer service skills, teamwork, and the ability to manage multiple priorities calmly, accurately, and on time. What You'll Be Doing Verify patients' insurance eligibility and coverage prior to appointments or procedures. Obtain insurance approved referrals by insurance guidelines for referred services. Maintain working knowledge of assigned insurance policies and referral guidelines. Verify referral accuracy and completeness, including diagnosis, provider, insurance, and urgency. Enter and maintain referral information accurately within the electronic medical record (EMR) Communicate clearly with patients regarding referral status, requirements, and next steps. Assist with incoming calls, tasks, and inquires related to billing, statements, eligibility, referrals, and authorization. Serve as a liaison between patients, providers, insurance companies, and referring offices. Monitor and follow up on pending, incomplete, or expired referrals to prevent delays in care. Perform other duties as assigned. What We're Looking For Willing to train Minimum of 1-2 years of experience in a medical office, insurance eligibility, or referral process Strong organization and communication skills (both verbal and written) Familiarity with medical terminology and insurance guidelines preferred Basic knowledge of CPT and ICD-10 codes preferred Excellent organization skills and ability to multitask Proficiency in Microsoft Office (Word, Excel, OneDrive, Outlook) Commitment to confidentiality and professionalism Detail-oriented mindset with a proactive, team-first attitude Pre-Employment Requirements Background check Pre-employment drug screening Employment is contingent upon successful completion of both. Why Join Us At North Idaho Eye Institute, you'll be part of a team that values collaboration, compassion, and excellence. Your role will be essential to creating a positive, efficient, and caring environment for every patient who walks through our doors.
