Eligibility Specialist

US Oncology Inc.; Ocala (FL); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Medical

Dental

Vision

Life Insurance

Short-term disability

Long-term disability

PTO

401k with match

Wellness program

Tuition Reimbursement

Employee Assistance Program

Retail discounts

Job summary

US Oncology Inc. is seeking a detail-oriented specialist to resubmit invoices and resolve eligibility variances while coordinating referrals and pre-authorizations. You will work with clinics to verify coverage and patient responsibility.

The role requires attention to documentation, HIPAA compliance, and the ability to handle complex payor interactions in a fast-paced oncology setting.

Qualifications

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

Responsibilities

• Researches and obtain accurate and current insurance coverage information and updates PMS.
• Evaluate benefits and eligibility to assess patient financial responsibility.
• Coordinate referrals and ensure appropriate authorizations are entered into the PMS.
• Identify uninsured patients and refer to patient benefit representative.
• Communicate system issues and payor trends to supervisor.
• Answer questions and resolve complaints when needed.
• Document conversations with payors in the PMS.
• Follow up on missing or incomplete documentation with clinics.
• Work ETM and TES edits as required.
• Manage complex payor eligibility and referrals.
• Research and respond to routine account inquiries and escalate non-routine issues.
• Identify processes to improve efficiencies and workflows.
• Adhere to confidentiality and HIPAA compliance.

Skills

Microsoft Office

Front desk experience

Healthcare benefits

Registrations

Education

High School Diploma or equivalent

Associate’s degree preferred

Tools

PMS (practice management system)

Job description

Why work for us

We offer our employees a competitive benefits package that includes 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, and lots of other great perks such as Tuition Reimbursement, an Employee Assistance program and 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.