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.
Prior Authorization / Eligibility / Referrals Representative Clinical Neurology Specialists - 2.7 Henderson, NV Job Details Full-time From $17 an hour 1 day ago Benefits Health insurance Dental insurance Paid time off Vision insurance 401(k) matching Qualifications Appeals Telephony Overseeing health insurance pre-certification Phone communication Medical insurance coverage verification Clinic experience Quality assurance Attention to detail Data entry Health insurance referral requirements Phone call management Full Job Description Before replying, please read and comprehend the full message. Applicants must meet the requirements listed below in order to be considered:
Job Title :
Prior Authorization / Eligibility / Referrals Representative Prior Authorization is an essential role within a health care organization. In order to be successful, you will engage with a range of people, including patients, caregivers, referring physician offices, insurance companies, healthcare professionals, and more. You will occasionally work in a high volume environment, thus in order to help our new and existing patients, referring providers and their staff, and your coworkers to the best of your abilities, you will need to become knowledgeable about our numerous services and policies/procedures.
Position Functions:
Demonstrates a commitment to patient service, organizational values and professionalism through appropriate conduct and demeanor at all times Responsible for verifying patient benefits eligibility, coordinating benefits and determining patient coverage/patient responsibility for services and generating referrals and follow up Responsible for interacting with patients, referring offices, and office team members Responsible for receiving inbound / placing outbound calls to insurance companies, patients and physician offices daily Interacting with patients, physicians and other health care professionals as well as members of patient assistance programs using web-based, telephony and face-to-face means of communication Submitting accurate prior authorizations to insurance companies Extracting key information and details from eligibility and prior auth results Data entry of authorization details, insurance eligibility details, and referrals made into the EMR Following up on prior auth submissions to meet deadlines and department goals Generating and sending referrals to other healthcare providers for continuity of care Working with healthcare providers and staff on prior auth appeals when indicated
Required Skills and Abilities:
Experience with Nevada insurances, including HMOs and insurance websites Experience and knowledge with local Nevada HMO insurance guidelines Experience working with web portals to check eligibility, submit prior auth, etc. Experience with high phone volume Skilled at attention to detail and quality assurance activities Ability to multi-task Ability to work Monday-Friday during standard hours Ability to work occasional weekend shift
Experience Requirements:
Minimum of two (2) years of recent experience working in an ambulatory clinic or hospital setting, primarily handling insurance eligibility and benefits as well as previous authorizations and referrals.
Job Type:
Full-time Pay:
From $17.00 per hour
Benefits:
401(k) matching Dental insurance Health insurance Paid time off Vision insurance
