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.
Overview Prepare and submit billing data for technical and professional, primary, and secondary medical claims to insurance companies. Follow up on unpaid, rejected, or denied claims. Resolve issues to resubmit claims in error. File appeals on denials when necessary. Correct patient insurance information as needed. Generate reports and process request for information. Report problems to appropriate department supervisor. Qualifications
EDUCATIONAL REQUIREMENT
High School diploma or general education degree (GED).
EXPERIENCE REQUIREMENTS
. At least six (6) months of experience in a related field.
COMPUTER SKILLS
An individual should have knowledge of Accounting software; Database software; Internet software; Spreadsheet software; and Word Processing software.
CERTIFICATES, LICENSES, REGISTRATION
Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating.
OTHER QUALIFICATIONS
The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE). Educated on and compliant with HIPAA regulations; maintain strict confidentiality of client information.
PHYSICAL DEMANDS
While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision and ability to adjust focus.
WORK ENVIRONMENT
The noise level in the work environment is usually moderate.
Qualifications:
EDUCATIONAL REQUIREMENT
High School diploma or general education degree (GED).
EXPERIENCE REQUIREMENTS
. At least six (6) months of experience in a related field.
COMPUTER SKILLS
An individual should have knowledge of Accounting software; Database software; Internet software; Spreadsheet software; and Word Processing software.
CERTIFICATES, LICENSES, REGISTRATION
Must possess a valid driver's license with a driving history verified through a motor vehicle report that meets requirements for Cherokee Nation underwriting rating.
OTHER QUALIFICATIONS
The employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG's Cumulative Sanction Report, or the GSA's List of Excluded Providers, or listed on the OIG's List of Excluded Individuals/Entities (LEIE). Educated on and compliant with HIPAA regulations; maintain strict confidentiality of client information.
PHYSICAL DEMANDS
While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision and ability to adjust focus.
WORK ENVIRONMENT
The noise level in the work environment is usually moderate.
