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Acadian Medical Center

CBO Collection Specialist

Career Insights for Eligibility Specialist

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What they do

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.

$47,935 / year median in Louisiana

+17% projected growth

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Job Description

1. Account follow-up with insurance companies; patients and their families to resolve outstanding balances. 2. Identify insurance company or proper party to be billed; identify and bill secondary or tertiary insurances. 3. Review insurance payments for accuracy and compliance with contract discounts. 4. Review denials or partially paid claims and work with the involved parties to resolve the discrepancy. 5. Receives accounts approved for Retro, assists with Retro-pre-cert as needed 6. Copies medical records as needed for payment of claim 7. Follows up with phone calls to payer every 2 weeks until processed for payment 8. Works up any registers, corrects denials, refiles, commenting and changing financial class 9. Files adjustments, late charges to insurance as needed 10. Refunds patient credit balance as needed 11. Assists in pre-cert and verification of benefits when needed 12. Assists co-workers with primary vs secondary insurance 13. Cross train and back up billing as needed 14. Answer questions pertaining to billings and insurance covering 15. Facilitate relationships between the hospital and patients and patient families. 16. Completes credit balance reports for Insurance plan as needed. 17. Any other duties assigned as needed to help drive our Mission and abide by our organizations values. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.