RCM Eligibility & Benefits Specialist

Description

Insurance verification support personnel to assist in quality assurance checks of benefit verifications for New and Skin Testing appointment types.

Responsibilities include, but are not limited to, the following:

• Efficiently retrieve information by utilizing payer websites or by phone, to identify any discrepancies or issues with the prior verification and clearly and concisely notify proper personnel.
• Identify report and keep notes on frequent or out of the ordinary trends and restrictions for unique payers by state.
• Navigate multiple payer websites proficiently, and maintain detailed notes on each.
• Become well versed on eligibility verification language and communication with insurance companies, as well as becoming familiar with different insurance payers limitations, exclusions, or other restrictions on a state-by-state and unique payer basis.
• Review verified plans to ensure accuracy using the designated payer websites and/or phone calls to insurance plans.
• Complete corrected verifications when necessary including importing a corrected verification form to patients file.
• Clearly demonstrate and communicate precisely where the error(s) occurred when providing feedback to the verifiers.
• Assist with last minute verifications online and by phone when needed and follow-up with verifiers after the fact to determine why the verification was initially missed.
• Ability to be very detailed in all tasks.
• Ability to work successfully under pressure.
• Provide status quickly and accurately of tasks at hand.

• Complete projects and other duties as requested.

• Demonstrate professionalism and promote positive interpersonal relations with all internal and external business contacts, representing the corporation in a positive manner, displaying personal commitment to achieving the goals and objectives of the corporation.

Other

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice to protect Central Billing Office operations by keeping information confidential.

• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends OSHA, HIPAA, and OIG training programs as required.
• Attends all meetings as requested including regular staff meetings.

• Attends Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.

• Performs any additional duties as requested by the Director of Central Billing Services and/or Manager / Supervisor.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Typical Physical Demands

Physical demands are moderate with occasional lifting of items weighing approximately 20-30 pounds. Position requires prolonged sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is also required. Employee must have normal range of hearing and vision must be correctable to normal range to record, prepare, and communicate appropriate reports.

Typical Working Conditions

Normal office environment. Occasional evening or weekend work.

Qualifications

EDUCATIONAL REQUIREMENTS:

• High school diploma. Healthcare or related experience required.

QUALIFICATIONS AND EXPERIENCE:

• One to three years of office experience, preferably in a healthcare setting.
• Excellent communication skills, both written and oral.
• Proficient computer skills including word processing, data entry and navigating medical insurance websites.
• Must have ability to communicate professionally and effectively with management, co-workers, hub personnel, and outside entities.
• Detail oriented with the ability to identify accuracy of information given from outside entities such as insurance companies and websites.
• Ability to work independently and stay focused on the task at hand.