Eligibility Specialist

PATH (People Assisting The Homeless) (Old); Riverside (CA); On-site; USD 32,000 - 40,000; Full time

Job summary

PATH (People Assisting The Homeless) is hiring an Eligibility Specialist in Riverside, CA. The role reviews patients’ insurance eligibility before visits and updates insurance details in patient profiles.

You will liaise with management and other departments to support eligibility and patient application processes. Responsibilities include verifying benefits, instructing patients on covered amounts, and handling billing-related activities while protecting confidential information.

Qualifications

• Working knowledge of medical terminology.
• Ability to work independently with strong critical thinking and time management.
• Typing speed of 45 words per minute or faster.
• Proficiency in Microsoft Office and basic computer skills.
• Strong customer service through verbal and written communication.
• Maintain professionalism and ethics in all interactions.
• Strong interpersonal skills and teamwork capabilities.
• Adaptable to changing situations and a stressful environment.

Responsibilities

• Review patients’ insurance eligibility prior to visits.
• Update insurance data into patients’ profiles and ensure accuracy.
• Coordinate with management and other departments for eligibility and applications.
• Explain benefit coverage to patients in clear terms.
• Follow security rules to protect sensitive patient information.
• Process payment approvals and assist with billing tasks.
• Maintain confidential patient files per regulatory requirements.

Skills

Medical terminology

Typing 45 wpm

Microsoft Office

Customer service

Professionalism

Interpersonal skills

Time management

Education

High School diploma

Associate’s Degree or Medical Billing Certificate

Tools

Microsoft Office

Job description

• Location 7880 Mission Grove Parkway South,Riverside, CA, 92508,United States


• Base Pay $23.00 - $29.39 / Hour


• Employee Type Full Time - Non-Exempt


• Required Degree High school


• Manage Others No

Contact information

• Name Amber Travis

Description

JOB SUMMARY:

The Eligibility Specialist has the responsibility for reviewing patients’ insurance to verify their eligibility for qualifying insurance coverage prior patient’s visit and updating the insurance information into patients’ profile. This position will assist the management team with oversight of both the patient eligibility and patient application processes by serving as a liaison between the client and other departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Determine if re-authorization needed for new order


• Verify insurance eligibility


• Call insurance companies to ascertain pertinent information regarding policies and payment benefits for patient


• Instruct patients on amounts covered under benefits plan in easy to understand terminology


• Retain strong medical terminology understanding in effort to better comprehend procedures


• Follow Specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information


• Sign payment approvals accepted claims


• Update all patient and insurance data regularly and carefully inputted changes into company’s computer system


• Handle billing related activities focused on medical specialties


• Examine claims, records and procedures to grant approval of coverage


• Check documentation for appropriate coding, catching errors and making revisions


• Verify that patient had proper insurance coverage prior to any procedures or appointment scheduling


• Create and maintain accurate and confidential patient files according to regulatory mandates


• Update patient financial information to promote accurate record keeping


• Perform all other duties as directed either formally or informally, verbally or in writing

SUPERVISORY RESPONSIBILITIES:

KNOWLEDGE, SKILLS AND ABILITIES:

• Working knowledge of medical terminology.


• Must be able to work independently while utilizing strong critical thinking/time management skills.


• Must be able to type 45 words per minute.


• Strong computer skills, with proficiency in Microsoft Office.


• Must possess good “customer service” including verbal and written communication.


• A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times.


• Possess strong interpersonal skills and ability to work well with others.


• Ability to deal effectively with changing situations and stressful environment.


• Ability to perform tasks related to physical activity to complete the responsibilities of the position

EXPERIENCE AND EDUCATION:

• High School graduate or equivalent


• Associate’s Degree in a related field and/or Medical Billing Certificate from an accredited school preferred


• Minimum 1 year of experience in medical billing, medical insurance and/or customer service