Eligibility Specialist (FT) - Remote

Optim; Oregon; Hybrid; USD 25,000 - 39,000; Full time

Benefits offered by this job

Competitive Pay

Company Benefits

Paid Time Off

Holiday Pay

401K Plan

Job summary

Optim Orthopedics is seeking a full-time Eligibility Specialist (Remote) to verify insurance coverage and benefits 48 hours prior to patient appointments. The role includes updating copay details in Athena and documenting notes in the patient account for the front desk.

You will monitor the EMR eligibility bucket, confirm authorizations, and assist in payment plan setup as needed, while maintaining HIPAA-compliant, accurate records.

Qualifications

• Experience handling insurance claims processing and eligibility checks.
• Proficient use of EMR and Practice Management Systems.
• Knowledge of HIPAA and patient confidentiality requirements.
• Accurate data entry and meticulous record keeping.

Responsibilities

• Review schedules 48 hours before appointments and verify insurance eligibility.
• Update copay information in Athena and annotate patient accounts.
• Monitor EMR eligibility bucket for upcoming visits and ensure authorizations are attached.
• Assist in setting up payment plans and escalate billing issues when needed.
• Identify trends or denial issues and recommend resolutions.

Skills

Insurance claims

EMR systems

HIPAA compliance

Data entry accuracy

Verbal communication

Documentation

Tools

Athena EMR

Practice Management System

Job description

Job Description

Optim Orthopedics is seeking a full time Eligibility Specialist/Remote.

Job Requirements

• Reviews clinic schedules 48 hours in advance of appointment for designated locations and checks all eligibility and benefits to ensure patient insurance is active. Will be required to contact patient if there is an issue with their insurance in advance of the appointment.
• Updates copay information in Athena and provides notes in the patient account for the front desk regarding co-insurance, deductibles due and collections of any balances due prior to patient's appointment.
• Monitors eligibility bucket in EMR for upcoming appointments. Reviews the patient's insurance for eligibility and benefits.
• Responsible for ongoing daily monitoring of EBT email group to assist Patient Access Coordinators with eligibility issues identified at the time of making the appointments.
• Responsible for verifying that authorizations are obtained and attached to the appropriate appointment at the time of the visit to ensure claim is submitted correctly and accurately.
• May assist Patient Account Coordinator as needed in setting up payment plans to help patients manage payment of bills.
• May assist in identifying and communicate any trends, denial issues or irregularity impacting resolution of patient accounts or daily production workflow to supervisor and other team members and recommend resolution.
• Must have a comprehensive understanding and knowledge of the insurance claim process, EOB and patient statement to assist patients as needed with questions.
• Forwards any billing issues identified to the appropriate staff to assist patients with resolution.
• Maintains up-to-date knowledge of third party billing and reimbursement, clinic's financial policies and industry knowledge.
• Must maintain accuracy in demographic and data entry in the EMR system.
• Uses electronic systems (email, Practice Management System and EMR) for communication to other staff members to have an accurate detail account in the patient record. Maintains professional and respectful documentation at all times in the patient record.
• Responds to patient calls timely and professional and documents appropriately in the patient chart.
• Completes annual compliance and regulatory requirements as applicable. Follows all work processes, procedures while maintaining compliance to the organizations rules and regulations.
• Protects and keeps all patient information confidential following all HIPAA, state and federal laws. Upholds and promotes patient safety and quality.
• Accepts ownership for all tasks and responsibilities while improving the company's reputation. Escalates any problems to the Manager or Supervisor as appropriate.
• Demonstrates and encourages team behavior and exceptional patient/guest experiences.
• May be required to serve as back up as needed for other Front Office positions for check in or check out.
• Other duties may be assigned.

Optim Offers

• Competitive Pay
• Company Benefits
• Paid Time Off
• Holiday Pay
• 401K Plan