Eligibility Specialist- Full-Time

The CORE Institute; Phoenix (AZ); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Monthly $43 stipend toward ancillary

HSA with qualifying HDHP plans with公司匹

401k plan after 6 months with company

Employee Assistance Program 24/7

Employee Appreciation Days

Employee Wellness Events

Job summary

The CORE Institute in Phoenix, AZ is seeking a Front Office / Billing Specialist to support the Physical Therapy program. You will verify benefits, obtain authorizations, and manage registrations at the point of care.

Key responsibilities include using practice management systems, communicating with insurers, and guiding patients through benefit options while maintaining excellent customer service.

Qualifications

• High school diploma or GED required; relevant experience preferred.
• 2–3 years in a healthcare environment with heavy insurance benefits verification.
• Experience in front desk or billing roles.

Responsibilities

• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations prior to patient arrival for all Physical Therapy services.
• Uses online verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
• Calls insurance companies to discuss physical therapy benefits and authorizations not available online.
• Completes Explanation of Insurance Benefits forms for patients and supports Front Office prep for arrivals.
• Verifies patient demographic information and insurance eligibility including coordination of benefits for claims processing.
• Reviews insurance denials and determines next steps to resolve issues.
• Researches information needed to complete the registration process with providers and patients.
• Engages with patients to review benefits and sets up payment options while delivering excellent customer service.
• Assists uninsured/underinsured patients by screening for Medicaid or charity resources.

Skills

Insurance verification

Front desk experience

Education

High school diploma/GED

Tools

Practice management system

Online verification portals

Job description

• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

Minimum Qualifications:

• High school diploma/GED or equivalent working knowledge preferred.
• Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role that includes heavy insurance benefits verification experience.

Essential Functions

• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations (referrals, precertification, authorizations) prior to patient arrival for all Physical Therapy services.
• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility. Calls insurance companies to discuss physical therapy benefits and authorizations that are not available through online resources.
• Completes Explanation of Insurance Benefits form for patients, new patient paperwork, and serves as a member of the front office team to prep Front Office Reps for the patient’s arrival. Maintains proper Appointment Status settings for each visit, as well as ensures proper authorizations are secured prior to the patient visit.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Reviews insurance denials and rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding denials/rejections.
• Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.
• Engages in conversations with patients to review benefits, insurance requirements, and processed claims, and sets up payment options for anticipated/outstanding balances while providing excellent customer service.
• Assists uninsured/underinsured patients by screening for appropriate community resources such as Medicaid or charity assistance programs.
• Maintains satisfactory productivity rates and ensures the department VOB process is maintained within departmental guidelines of verifying benefits 3 weeks prior to the visit (except for add-ons)
• As part of the Physical Therapy front office team, the specialist will complete daily requests, work through obstacles to solve issues/problems for multiple clinics and providers, and cross-train to assist/fill in as front office support as needed to cover staff shortages or busy periods.
• Identifies and communicates trends and/or potential issues to the management team, and shares information with regard to payer rules and guidelines. Suggests process improvements and works as an integral team member of the front office team.
• Provides research, problem-solving, and reporting functions to assist management and front office team in meeting departmental metrics, quality standards, and enhanced operations.

About us:

The Center for Orthopedic Research and Education, We don't mean to brag but did you knowThe CORE Institutehas been ranked by Ranking Arizona: The Best of Arizona Businesses!?

• #1 for Orthopedic Practices
• #1 for Healthiest Healthcare Employers
• #3 for Best Healthcare Workplace Culture
• Winner in Best Places to Work

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.