Eligibility Specialist

The US Oncology Network; Ocala (FL); On-site; USD 38,000 - 48,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Life Insurance

Disability coverage (short-term & long

Disability coverage (short-term & long

Job summary

US Oncology Inc. in Ocala, FL is seeking an Insurance/Eligibility Specialist to support patient billing processes. You will resubmit invoices, verify benefits, determine patient financial responsibility, and coordinate referrals and retro-authorizations where applicable.

The role requires strong computer skills, front desk experience, and proficiency with PMS and Office applications. Compliance with HIPAA and company standards is essential.

Qualifications

• High school diploma or equivalent required; an associate degree is preferred.
• Three years of experience with front desk, registrations, or healthcare benefits.
• Proficiency with computer systems and Microsoft Office (Word and Excel).

Responsibilities

• Resubmit invoices to the responsible party and resolve eligibility variances.
• Coordinate referrals and retro-authorizations where applicable.
• Follow procedures and guidelines to complete tasks and maintain compliance.
• Document conversations with payors and track in the PMS system.
• Identify and communicate payor issues, process improvements, and non-routine cases.
• Maintain confidentiality and adhere to HIPAA and related laws.

Skills

Microsoft Office

Front desk experience

Healthcare benefits knowledge

Education

High school diploma

Associates degree preferred

Tools

PMS

Job description

Overview

Why work for us:

• Medical
• Dental
• Vision
• Life Insurance
• Short-term and Long-term disability coverage
• a generous PTO program
• a 401k plan that comes with a company match
• a Wellness program that rewards you practicing a healthy lifestyle
• Tuition Reimbursement
• an Employee Assistance program
• discounts on some of your favorite retailers

Scope

Under general supervision, is responsible for the successful resubmission of invoices to the responsible party. Analyzes and resolves eligibility variances via web research and/or direct contact with patients. Coordinates the activities for the acquisition of referrals and retro-authorizations, where applicable. Follows standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Researches and obtain accurate and current insurance coverage information, makes corresponding corrections in the PMS.
• May evaluate benefits and eligibility to assess patient financial responsibility.
• May coordinates referral from primary care clinic to ensure appropriate authorizations are secured and entered into the PMS.
• Identifies uninsured patients and refers to patient benefit representative for coordination of payment.
• Communicates system issues and/or payor trends lead or supervisor.
• May answer questions and resolve complaints.
• Documents conversations with payors in the PMS.
• Contacts and follows up with clinic or any missing or incomplete documentation.
• Works ETM and TES edits.
• Manages complex payor eligibility and referrals.
• Researches and responds to routine account inquiries and takes appropriate action; escalates non-routine issues, makes recommendations for solutions to unique situations.
• Identifies processes and procedures to improve efficiencies.
• Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records and collections.
• Other duties as requested or assigned.

Qualifications

MINIMAL QUALIFICATIONS: High school diploma or equivalent required. Associates degree preferred. Position requires three (3) years with front desk, registrations, healthcare benefits or equivalent experience. Proficiency with computer systems and Microsoft Office (Word and Excel) required.

COMPETENCIES: Uses Technical and Functional Experience: Possesses up to date knowledge of the profession and industry; accesses and uses other expert resources when appropriate. Demonstrates Adaptability: Handles day to day work challenges confidently; is willing and able to adjust to multiple demands, shifting priorities, ambiguity, and rapid change; shows resilience in the face of constraints, frustrations, or adversity; demonstrates flexibility. Uses Sound Judgment: Makes timely, cost effective and sound decisions; makes decisions under conditions of uncertainty. Shows Work Commitment: Sets high standards of performance; pursues aggressive goals and works efficiently to achieve them. Commits to Quality: Emphasizes the need to deliver quality products and/or services; defines standards for quality and evaluated products, processes, and service against those standards; manages quality; improves efficiencies.

PHYISICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

WORK ENVIRONMENT

The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.