Eligibility Specialist

We are seeking a dedicated Eligibility Specialist to join our Revenue Cycle team. The ideal candidate will be responsible for verifying patient insurance coverage and ensuring eligibility for services, while also maintaining a smooth billing process. You will play a critical role in ensuring patients understand their coverage and financial responsibility before services are rendered by our clinicians. This role requires strong attention to detail, exceptional communication skills, and experience with systems like AthenaHealth, payer portals, and Zendesk.

Business impact 📈  

• Accurately verify patient insurance coverage, benefits, and eligibility using systems like AthenaHealth and payer portals.
• Obtain and track pre-authorizations for services when required by the payer.
• Identify primary and secondary insurance coverage to ensure proper coordination of benefits and avoid future claim denials.
• Maintain accurate and up-to-date documentation of insurance verification outcomes in the system, ensuring billing compliance.
• Collaborate with billing specialists and patients to resolve eligibility-related issues, claim holds, or denials.
• In collaboration with Operations team, maintain proprietary insurance-provider mapping database to ensure billing compliance 
• Notify patients of any discrepancies in coverage or issues with their insurance eligibility, providing patients with clear guidance and options.
• Ensure patient insurance information is correctly recorded and maintained for accurate billing and reimbursement.
• Conduct follow-up on pending insurance verifications to prevent delays in billing or service delivery.
• Use AthenaHealth, payer portals and other tools efficiently to confirm patient eligibility and verify coverage before appointments.