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.
Job overview: An Insurance Coordinator takes ownership of each referral and works with purpose and urgency to remove financial and insurance barriers to treatment. They proactively follow through on outstanding requirements, escalate barriers when needed, and understand that delays in insurance and financial clearance can directly delay patient care. Ability to complete a minimum of 15+ benefit investigations per day, including verification of coverage and benefits authorization requirements, patient financial responsibility, and timely documentation and follow-up.
Key Responsibilities:
1. Eligibility & Coverage Verification Verify active coverage and confirm the patient's insurance information for the applicable treatment dates 2. Plan-of-Care Benefit Verification Verify benefits specific to the prescribed medication, services, site of care, and treatment dates—not simply whether the patient has active insurance. 3. Prior Authorization & Referral Coordination Determine whether prior authorization and/or a PCP referral is required, obtain it when necessary, and ensure the approval accurately covers the prescribed treatment. 4. Patient Financial Responsibility Review the applicable deductible, copay, coinsurance, out-of-pocket status, and other benefit information to calculate the patient's anticipated financial responsibility for treatment. 5. Patient/Caregiver Communication & Financial Clearance Clearly explain coverage, authorization status, and anticipated financial responsibility to the patient or caregiver; answer questions; obtain required signed consent forms; and secure required payment before treatment. 6. Documentation & Handoff Accurately document insurance verification, benefits, authorization/referral information, patient communication, consents, and payment status so the next team member can clearly see that the patient is ready to move forward. 7. Ongoing Treatment Verification Perform monthly eligibility checks for all active patients and verify prior authorization and/or PCP referrals are still valid for next treatment date.
Skills and Qualifications:
High school diploma or equivalent. Previous experience in insurance verification for IV medications. Familiarity with insurance software systems (Availity, UHC, Cigna, etc.). Ability to manage complex information accurately. Strong verbal and written communication skills to handle interactions with insurance, providers, patients, and internal teams. Capacity to resolve issues related to denied or underpaid claims efficiently.
Schedule :
• Monday thru Friday, 8a-5:30p, with occasional overtime as needed.
On-site Pay:
$22.00 - $25.00 per hour
Benefits:
401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Health savings account Paid time off Vision insurance
