Job Title: Eligibility Specialist

Role and Responsibilities

· Insurance verification and authorizations - confirm patients' insurance eligibility, benefits, and coverage limitations via payer portals or telephone.

· Determines the level of benefits to which the patient is entitled to services offered in office

· Verify Benefits- Co pays, Deductible, Co-Insurance amounts

· Inform patients of coverage issues, sliding fee scales, or financial responsibilities.

· Properly analyzes various payor eligibility responses to find the information needed to complete verifications

· Obtain, track, and manage pre-authorizations or referrals for services.

· Identify primary/secondary insurance, resolve eligibility-related claim holds or denials, and coordinate with billing staff.

· Monitors on-going eligibility by obtaining periodic updated information of eligibility factors and takes appropriate actions on changes

· Consistently check dashboard on Clearwave system for denials and errors for auths that aren't going through system.

· Works with patients to obtain complete and accurate insurance information, discusses eligibility results in alternative payment methods

· Responds to questions and complaints of patients when needed

Qualifications and Education Requirements

· Prior experience in a medical office, insurance company, or revenue cycle management.

· High School graduate or equivalent

· Proficiency in EHR systems (e.g., Athena Health), payer portals, and Microsoft Office.

· Strong knowledge of medical terminology, ICD-10, and CPT codes.

· Ability to work independently.

· Ability to handle high-volume, time-sensitive tasks in a fast-paced environment.

· Excellent interpersonal skills to communicate with patients and insurance representatives.

· Team player, work well with others

· Works efficiently and accurately

· Flexibility and dependability

· Maintain a high degree of confidentiality

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, and Los Angeles County Fair Chance Ordinance.