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Med Office Billing Clrk-Assoc
Career Insights for Eligibility Specialist
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Scorecard
Based on Texas data
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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.
$46,315 / year median in Texas
+19% projected growth
Job Description
Under direct supervision, responsible for performing any combination of routine calculating, posting and verifying duties to obtain primary insurance data for use in preparing statements to patients' insurance carriers. May prepare notices to patients of amount expected (or received) from insurance and amount expected from patient. Detail oriented with the ability to organize, prioritize and coordinate work within schedule constraints and handle emergent requirements in a timely manner. Ability to monitor important and complex projects concurrently. Knowledge of Microsoft Word, Excel, PowerPoint, and Lotus Notes/other email software. Ability to effectively communicate orally and in writing, to include writing and preparing memorandums, letters, and other official correspondence. Education High School Diploma or equivalent Performs any combination of routine verification and authorization to obtain insurance data for use in preparing statements to patient's insurance carriers. Obtains referral/authorization for scheduled services. Verifies insurance coverage with insurance companies and state agency programs. Accepts payments from patients or patient representatives. Sets up payment arrangements based on payment plan policy. Processes in-bound calls from patients, patient representatives, insurance companies, and other departments to provide assistance and resolve patient account billing inquiries. Resolves other billing inquiry assignments. Resolves inquiries in a quick and accurate manner based on policies and procedures. Maintains records of contacts and agreements with patients or patient representatives. Ensures integrity and completeness of account system to include demographics, coverage and guarantor information with an emphasis on denial management. Responsible for account maintenance quality as directed by management team in accordance with system policy and processes. Responsible for telephone eligibility support. Participates in quality control and solution recommendations to include notification to management team of process issues. Prepares accurate and thorough documentation of all issues related to team business within Epic PM. Performs all other duties as assigned.