Patient Eligibility Specialist

This is a non-exempt on-site role, located at our New Providence CBO location and is part of Prism Vision Group.

Compensation Range: $18-$35.50/hr (Dependent on Experience)

Key contributor to clinical and revenue cycle operations, a Patient Eligibility Specialist plays a pivotal role in managing patient information, verifying patient treatment eligibility through meticulous insurance processes, and supporting patient care through the accurate preparation of medical charts. This role demands a dynamic individual capable of navigating complex insurance systems and contributing positively to team dynamics.

ROLE AND RESPONSIBILITIES

• Insurance Verification: Confirm patient insurance details, including detailed benefits and referrals, to ensure eligibility and secure financial reimbursement ahead of service delivery.

• Appointment Coordination: Analyze patient information to verify the appropriateness of appointment types,employing analytical skills for optimal scheduling.

• Chart Management: Prepare and review electronic medical charts, understanding minimal clinical requirements to match treatments with diagnoses.

• Financial Clearance: Accurately gather and verify all patient demographic, financial, and insurance information, ensuring comprehensive financial clearance. This includes obtaining necessary referrals, authorizations, and pre-certifications to mitigate denials and secure reimbursement.

• Patient Communication: Inform patients/guarantors about their benefits, authorization needs, and out-of-pocket responsibilities, including co-pays, deductibles, and co- insurance.

• Prior Authorization: Efficiently manage prior authorization demands, including reviewing patient diagnoses, communicating with insurance carriers, and utilizing insurance portals for submission.

• Compliance and Communication: Maintain patient confidentiality, contribute positively to team dynamics, and engage in continuous professional development through meetings and seminars.

• Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity.

• Other duties as assigned.• Aids with ad-hoc, special projects, as needed.

POSITION QUALIFICATIONS

Education: High School Diploma or GED required.
Experience: 1+ years of experience and knowledge in medical services profession, insurance plans, revenue cycle, or a
combination of all. Familiarity with Practice Management systems.

KNOWLEDGE/SKILLS/ABILITIES

• Accountability – Ability to accept responsibility and account for his/her actions and work performed. Willing to accept constructive feedback.
• Accuracy – Ability to perform work accurately and thoroughly with attention to all details of a project or task.
• Adaptability – Ability to adapt to and facilitate change in the workplace.
• Communication – Ability to communicate effectively with others using good listening skills.
• Empathetic – Ability to appreciate and be sensitive to the feelings of patients and co-workers.
• Initiative – Ability to make decisions and take actions to solve a problem or reach a goal. Desire to excel, attempting non-routine tasks.
• Judgment – Ability to make sound decisions using available information.
• Reliability – Can be relied upon to demonstrate reliability in attendance and punctuality.
• Team Player – The ability to work with others and independently for a common goal. Puts aside own individual needs to work toward the larger group objective and reinforces the contribution of others.
• Prior healthcare experience
• Insurance Knowledge: Familiarity with insurance referral and reimbursement criteria.
• Communication: Exceptional verbal and written communication skills.
• Analytical Proficiency: Strong critical thinking, analytical, and problem-solving abilities, coupled with excellent patient care orientation.
• Excellent interpersonal skills and ability to work effectively with physicians, co-workers, other departments and patients of all ages, and from across a broad range of cultural and social economic backgrounds.
• Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in accordance with established policies and HIPAA regulations.
• Demeanor: Personable, outgoing, and friendly, fostering positive interactions and relationships.
• Work Ethic: Demonstrates flexibility and adaptability, capable of thriving independently and as an integral part of a team in dynamic environments.
• Self-Management: Ability to work independently in a fast-paced environment, maintaining professionalism and confidentiality in line with HIPAA regulations.
• Technical Skills: High proficiency in Microsoft Office Suite, especially Excel, and the ability to navigate and master various electronic systems.
• Computer Proficiency, Microsoft Office to include Word, Excel, Power Point

WORK ENVIRONMENT

An office environment with a controlled atmosphere.