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.
Manager of Business Operations Position Summary The Referral Coordinator / Insurance Verifier plays a vital role in ensuring patients receive timely, coordinated care while supporting accurate reimbursement. This position is responsible for managing provider referrals and verifying patient insurance coverage, benefits, and authorization requirements. Serving as a key liaison between patients, providers, and insurance carriers, this role requires strong attention to detail, a working knowledge of insurance processes, and excellent communication skills to support efficient patient flow and regulatory compliance. Essential Duties and Responsibilities Receive, review, and process incoming and outgoing referrals in compliance with payer and organizational requirements Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements prior to services being rendered Obtain prior authorizations and referrals from insurance carriers, primary care providers, and specialists as required Accurately document insurance verification details, referral status, authorization numbers, and related communications in the EHR or practice management system Communicate clearly with patients regarding insurance coverage, referral requirements, financial responsibility, and next steps in scheduling care Coordinate with clinical staff, scheduling teams, and external provider offices to ensure referrals are complete and services are scheduled appropriately Contact insurance companies to clarify benefits, resolve discrepancies, appeal authorization or referral denials, and confirm payer policies Monitor referral and authorization turnaround times to minimize delays in patient care Maintain compliance with HIPAA, payer contracts, and organizational policies when handling protected health information (PHI) Identify and escalate insurance coverage issues, referral denials, or incomplete documentation to appropriate leadership or billing teams Support billing and revenue cycle processes by ensuring all referrals and authorizations are complete and accurate prior to claim submission Stay current on changes in insurance plans, referral guidelines, and authorization requirements for common payers Supervision Performs job duties with minimal supervision InternalExternal Relationships Internal Interactions Demonstrates professionalism, respect, and collaboration with coworkers and management Works collaboratively and provides assistance to team members as needed External Interactions Treats patients and customers as a priority in all interactions Communicates effectively and compassionately to address patient questions and concerns Demonstrates respect and sensitivity to diverse cultures, backgrounds, and needs Equipment Used Standard office equipment including computer, telephone, fax machine, and copier Working EnvironmentPhysical Requirements Primarily seated work with occasional walking, standing, bending, lifting, and carrying (up to 50 lbs) Visual and hearing acuity required (corrective devices permitted) May be exposed to infectious or contagious diseases May be required to handle emergency or crisis situations Occasional irregular hours, oncall, or callin support may be required May be required to wear personal protective equipment (PPE) as necessary
Bloodborne Pathogen Exposure:
No exposure Minimum Qualifications Education High school diploma or equivalent Experience Minimum of two (2) years' experience in a hospital or medicalrelated environment Working knowledge of medical insurance and the insurance industry required At least one (1) year of customer service experience SkillsTraining Proficiency with computers and standard office equipment Strong organizational skills, attention to detail, and communication abilities Patient Population Served All age groups: adolescent, adult, pediatric, and geriatric TravelOnCall Requirements Travel to other Vista Health sites may be required Oncall and callin support required as needed to meet departmental or facility staffing needs Licensure / Certification No licensure or certification required Equal Opportunity StatementDisclaimer Vista Health System is an equal opportunity employer. This job description is not a contract of employment, and job duties may be modified or expanded based on organizational needs.
