Eligibility Specialist

Wesley Family Services; Pittsburgh (Allegheny County); On-site; USD 42,000 - 66,000; Full time

Benefits offered by this job

Tuition discounts

Annual evaluations with pay increase

Employee Assistance Program

Free licensure supervision

Wellness Center

myStrength

Insurance discounts

Job summary

Wesley Family Services in Pittsburgh, PA is seeking an Eligibility Specialist to join the Finance team. You will handle authorization of services, pre-billing activities, and employee credentialing for all payers, ensuring accuracy of client eligibility and authorization status.

The role requires attention to detail, administrative support experience in healthcare, and proficiency with Microsoft Office. You will regularly coordinate with payers, process authorizations, and maintain compliance

Qualifications

• Minimum of a high school diploma or GED; Human Services or Business certificate or degree preferred.
• 3 years of administrative support experience in medical office or human services field and 3 years advanced level experience with Microsoft Office applications (Word, PowerPoint, Excel, Access, Outlook).
• PA Child Abuse, PA Criminal, and FBI Background Clearances obtained prior to start.

Responsibilities

• Runs eMedical daily for assigned programs.
• Updates electronic medical record (EMR) with insurance changes.
• Updates and enters authorizations and re-authorizations into EMR timely.
• Reviews plans and ensures commercial insurance is maintained throughout consumer treatment, updates EMR as needed to ensure correct billing.
• Follows close out procedures.
• Responsible for ACT 62 compliance as applicable to individual consumers.
• Manages the pre-closing report to make sure that all active clients are receiving services.

Skills

Administrative support

Detail oriented

Payer coordination

Education

High school diploma or GED

Human Services certificate

Business certificate or degree

Tools

Microsoft Office

Job description

Wesley Family Services is seeking an attentive and detail driven Eligibility Specialist to join our Finance team. The Eligibility Specialist is responsible for activities involved with authorization of services and other pre-billing/activities. Eligibility is responsible for employee credentialing application and maintenance for all payers. This position regularly coordinates with all payers of services provided. This position also processes authorization for the program and assures accuracy of client eligibility and authorization status.

• Education: Minimum of a high school diploma or GED. Human Services or Business certificate or degree preferred.
• Experience: 3 years of providing administrative support, relative to medical office or human services field AND 3 years advanced level experience and proficiency with Microsoft Office applications, including word, PowerPoint, excel, access, outlook.
• Licenses, Certifications & Clearances: PA Child Abuse, PA Criminal, and FBI Background Clearances obtained prior to start.

Responsibilities and Duties (full description available at https://wfspa.org)

• Runs eMedical daily for assigned programs.
• Updates electronic medical record (EMR) with insurance changes.
• Updates and enters authorizations and re-authorizations into electronic medical record timely.
• Reviews plans and ensures commercial insurance is maintained throughout consumer treatment, updates EMR as needed to ensure correct billing.
• Follows close out procedures.
• Responsible for ACT 62 compliance as applicable to individual consumers.
• Manages the pre-closing report to make sure that all active clients are receiving services.

Wesley Family Services offers the following benefits:

ALL EMPLOYEES:

• Tuition discounts - up to a 20% discount on tuition for certain degree programs at local partnering colleges
• Annual performance evaluations with pay increase eligibility
• Employee Assistance Program
• Free licensure supervision (minimum work hours may apply)
• WFS Wellness Center
• myStrength
• Discounted home, auto, and pet insurance

FULL TIME EMPLOYEES:

• 10 paid holidays + paid Celebration Day
• 15 paid time off days 1st year, 20 paid time off days 2nd year, continues to increase
• Tuition reimbursement for qualifying courses of up to $2,000 per semester or course ($6,000 per fiscal year maximum reimbursement)
• Medical, dental, and vision insurance (effective the 1st of the month following 30 days of work)
• Two weeks paid parental leave
• Employer paid life insurance
• Employer paid short term and long term disability insurance

Quality Whole Person Care® is Wesley Family Services’ service philosophy that aims to enhance the clinical care provided to individuals served while also helping to strengthen the way we support one another as colleagues. WFS has embedded QWPC practices which emphasize every person has value in all aspects of services and work-place culture.

Wesley Family Services is proud to be an Equal Opportunity Employer. Our policies for both current and prospective employees prohibits discrimination on the basis of race, color, religious creed, disability, ancestry, national origin (including limited English proficiency), age, sex assigned at birth, sexual orientation, transgender identity, gender transition, gender identity, gender expression, military or veteran status.