Eligibility Specialist

Eligibility Specialist 

The Eligibility Specialist is responsible for all administrative processing in regard to existing patient’s insurance information for a group of dialysis clinics or financial classes. This individual cooperates and works closely with both internal and remote co-workers, possesses strong time management skills and the ability to complete assigned job duties with applicable supervisory
direction, including exercising job appropriate judgement.

Essential Functions:
1. Completes insurance benefit verifications via phone or online verification tools to confirm patient benefits, specific to the rendering clinic.
2. Maintains accuracy of patient insurance in billing system and initiates updates as needed.
3. Completes and maintains region, clinic, and/or financial class specific reports related to new or inactive insurances.
4. Coordinates with clinic staff, collections department, Insurance Specialists, and other Admissions Department staff to ensure timely verification and accurate set up of patient insurance changes.
5. Acts as first point of contact for existing patient or clinic staff questions related to coordination of benefits or insurance changes. Escalates difficult conversations as necessary.
6. Communicates timely with patients, clinic staff, and other internal departments as needed when patient’s lose insurance benefits for dialysis.
7. Initiates requests for authorization as needed based on insurance requirements and clinic network status.
8. Resolves billing issues related to insurance set up.
9. Ensures compliance with CMS coordination of benefits rules.
10. Ensures confidentiality of all data, including patient, employee and operational data.
11. Adapts and is flexible when change arises, alternating between tasks as needed.
12. Stays current with department changes and updates and willingly learns new skills.
13. Handles patient information with discretion and sensitivity and maintains HIPAA compliance.
14. Understands and complies with Medicare rules and regulations, as well as applicable federal, state, agency, region and clinic rules and regulations.
15. Performs other tasks, duties and projects as assigned.

Position Type, Expected Hours of Work & Travel:

This is a Full-Time position. Hybrid, on-site, or remote work options available. Days and hours of work are Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m. Hours are based on regions supported. Travel is not expected with this position.

Required Education and Experience:

- Bachelor’s degree required. Focus in business or healthcare management preferred.

- 0-2 years of experience in similar administrative setting. Combination of degree and work experience will be considered.

- Bilingual in Spanish is helpful, but not required.

- Excellent customer service skills, oral and written communication skills, and demonstrated ability to actively contribute as a team player with superior attention to detail.

- Demonstrated ability to multi-task and work in a fast-paced environment while meeting deadlines and maintaining high standards of accuracy.

- Proficiency in Microsoft Office Suite.

AAP/EEO Statement:

Innovative Renal Care is an equal opportunity employer and a drug free workplace. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, sexual orientation, gender identity, national origin, citizenship, disability, or protected veteran status.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)