Sr Eligibility Specialist RCM

JOB SUMMARY

The Sr. Eligibility Specialist, RCM, will be responsible for overseeing the eligibility verification process within the revenue cycle, ensuring that patient insurance eligibility and benefits are accurately validated in a timely manner. This role involves managing complex eligibility cases, working closely with payers, and ensuring compliance with insurance policies. The Sr. Eligibility Specialist will also serve as a resource for junior team members, providing guidance, troubleshooting complex issues, and ensuring the efficient flow of patient registration and billing processes.

KEY RESPONSIBILITIES

• Manage and oversee the verification of patient eligibility and benefits for all insurance payers, ensuring accuracy and completeness of information. Identify and resolve eligibility discrepancies to avoid delays in billing and reimbursement.
• Handle complex or escalated eligibility issues, collaborating with payers and other departments as needed to resolve issues and ensure timely, accurate solutions.
• Provide mentorship and guidance to junior eligibility specialists, offering expertise in handling advanced problems. Help resolve challenging cases and ensure that team members understand best practices and procedures.
• Work closely with the billing, coding, and payer relations teams to ensure that all eligibility and benefit verification issues are addressed proactively and efficiently.
• Maintain accurate and up-to-date eligibility information in payer systems. Stay updated on changes in payer policies and insurance coverage requirements to mitigate the risk of claim denials.
• Generate and review reports related to eligibility verification on payer-specific trends, discrepancies, and best practices for eligibility verification.
• Review and analyze reports related to eligibility verification performance, identifying trends, discrepancies, and areas for improvement. Share insights with management to drive improvements in the verification process.

EEO STATEMENT

Baylor Genetics is proud to be an equal opportunity employer dedicated to building an inclusive and diverse workforce. We do not discriminate based on race, religion, color, national origin, sex, sexual orientation, age, gender identity, veteran status, disability, genetic information, pregnancy, childbirth, or related medical conditions, or any other status protected under applicable federal, state, or local law.

Note to Recruiters:

We value building direct relationships with our candidates and prefer to manage our hiring process internally. While we occasionally partner with select recruitment agencies for specialized roles, we do not accept unsolicited resumes from recruiters or agencies without a written agreement executed by the authorized signatory for Baylor Genetics ("Agreement"). Any resumes submitted to Baylor Genetics in the absence of an Agreement executed by Baylor Genetics authorized signatory will be considered the property of Baylor Genetics, and Baylor Genetics will not be obligated to pay any associated recruitment fees.