Eligibility Verification & Benefit Specialist

Astera Cancer Care; Northern (KY); Hybrid; USD 36,000 - 52,000; Full time

Job summary

OneOncology is seeking an Eligibility Verification and Benefit Specialist to verify new patients entered into the Practice Management system and identify any benefits issues. You will flag accounts, enter referrals, and keep staff informed of insurance changes and COB knowledge.

The role emphasizes accuracy, strong communication, and proficiency with EMR and scheduling systems to support physician-driven care.

Qualifications

• High School diploma or equivalent.
• One year experience in a related role preferred, but not required.
• Proficiency with MS Word, Excel, and Outlook.
• Strong customer service and communication skills.
• Knowledge of medical terminology.

Responsibilities

• Verify new patients in the Practice Management system.
• Identify benefits issues from the electronic verification system.
• Flag accounts with potential benefit issues and notify staff.
• Enter initial referrals and notify the Sr. Eligibility Verification and Benefit Specialist.
• Maintain knowledge of Coordination of Benefits and related claim issues.
• Communicate insurance changes to staff and update EMR.
• Document coverage comments in EMR when reimbursement is evaluated.
• Escalate issues to team management as needed.

Skills

MS Word

MS Excel

Outlook

Customer service

Communication

Data entry

Education

High School diploma or equivalent

Tools

EMR system

Patient scheduling system

Practice Management system

Job description

Why join us?

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision. Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description: Role Summary

Eligibility Verification and Benefit Specialist are responsible for verifying all new patients entering the Practice Management system including hospital patients.

Identify any possible benefits issues or trends based on responses from the electronic verification system.

Responsibilities

Work and complete new patient task and performs initial verification on all new patients for assigned locations prior to appointment.

Check daily the electronic verification system to identify any possible benefit issues for patients with same day or future appointments and communicates any concerns to the appropriate staff.

Properly flags accounts on possible benefit issues by documenting accounts and notifying appropriate parties as necessary.

Requests initial referral for appropriate patient appointments, enters documentation into Patient Management system, and notifies the Sr. Eligibility Verification and Benefit Specialist.

Maintains working knowledge of Coordination of Benefits as it relates to identifying possible claim issues prior to patient visit.

Stays current on insurance changes utilizing all resources available (web sites, bulletins, emails, etc).

Communicate any insurance changes to appropriate staff.

Communicate when a patient becomes Self Pay, or obtains insurance after being Self Pay to the appropriate staff.

Documents coverage comments in Electronic Medical Record (EMR) system when reimbursement should be evaluated.

Communicates with the team supervisors regarding issues with payer responses or trends in the electronic eligibility system.

Follows policies and procedures as outlined by management to ensure standardization of processes.

Notifies Eligibility Verification and Benefit Team Management of any issues that have potential for a negative outcome for the company.

Required Qualifications

EDUCATION & EXPERIENCE: High School diploma or equivalent.

One year experience in a directly related role preferred, but not required.

Essential Competencies

• Attendance is an essential job function.
• Ability to work effectively with all levels of management and other colleagues.
• Ability to demonstrate initiative and mature judgment.
• Ability to demonstrate high degree of professionalism and adaptability.
• Ability to demonstrate proficiency in the use of end-user computer applications (MS work, Excel, Outlook), database and patient scheduling and other medical information systems.
• Ability to demonstrate strong customer service delivery skills.
• Ability to utilize websites, portal and electronic options when available to increase efficiency.
• Ability to follow oral and written instructions.
• Ability to recognize and solve problems using creative thinking skills, hands on problem solving skills and the ability to analyze and respond to data.
• Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
• Skilled at Multi-tasking, organizational skills and superb attention to detail.
• Working knowledge of Hospice and other payer requirements.
• Knowledge of clinic office procedures, medical practice and medical terminology.

The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.

Build a Career That Makes a Difference

At New York Oncology Hematology (NYOH), we’re more than just the Capital Region’s leader in cancer care and blood disorders—we’re a team of passionate professionals united by a shared mission: to provide compassionate, cutting-edge care to thousands of patients each year.

With six state-of-the-art cancer centers across Albany, Amsterdam, Clifton Park, Hudson, and Troy—and a dedicated women’s imaging center, Akira Medical Imaging + Wellness—we bring advanced treatment close to home.

Our team includes 35 board-certified physicians and more than 300 cancer care specialists, all working together across medical oncology, radiation oncology, hematology and gynecologic oncology and surgery.

At NYOH, we are committed to delivering excellent health care to help our patients continue to tell their story.

If you’re looking for more than just a job—if you want a career with purpose—join us and be part of a community that’s changing lives and shaping the future of cancer care.