Eligibility Specialist (FT) - Remote

Optim Orthopedics; Savannah (GA); Remote; USD 42,000 - 56,000; Full time

Job summary

Optim Orthopedics is seeking a full-time Eligibility Specialist/Remote. The role is based in Savannah, GA, but offers remote work options.

The specialist will review schedules, verify insurance eligibility and benefits, update copay information in Athena, monitor EMR eligibility, and assist in resolving billing and authorization issues to ensure accurate and timely patient scheduling. The position emphasizes HIPAA compliance, accurate data entry, and collaboration with front desk staff and

Qualifications

• Experience verifying insurance eligibility and benefits.
• Knowledge of the insurance claim process, EOBs and patient statements.
• Maintain HIPAA compliance and confidentiality in handling patient information.
• Accurate demographic and data entry in EMR systems.

Responsibilities

• Review clinic schedules 48 hours in advance for designated locations.
• Update copay information in Athena and note co-insurance, deductibles, and balances due before appointments.
• Monitor eligibility in EMR for upcoming appointments and verify insurance status.
• Assist with eligibility issues identified by Patient Access Coordinators.
• Verify authorizations are obtained and attached to the appropriate appointment.
• Possibly assist in setting up payment plans for patients.
• Identify trends or issues affecting accounts and communicate resolutions to supervisor.
• Escalate problems to Manager or Supervisor as appropriate.
• Maintain professional documentation and respond to patient calls promptly.

Skills

Insurance eligibility

EMR systems

Practice Management System

Data entry accuracy

HIPAA compliance

Patient communication

Billing and collections

Tools

Athena

EMR

Practice Management System

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Eligibility Specialist (FT) - Remote

Eligibility OO Full-time Regular Savannah, GA, US

7 days ago Requisition ID: 2778

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.