Patient Access & Eligibility Specialist

Brault; San Dimas (CA); On-site; USD 42,000 - 64,000; Full time

Job summary

Brault is seeking a detail‑oriented healthcare data specialist to review, verify, and fill missing registration/insurance information on encounters. You will apply payer requirements, update demographic records, and ensure accurate billing information.

The role supports multiple client accounts, works with RICA and AthenaIDX tools, and targets a 95% accuracy rate while adhering to company policies and timelines.

Qualifications

• Strong attention to detail and accuracy; identify discrepancies in demographic and insurance information.
• Ability to interpret eligibility files and understand payer requirements, rules, and coverage limitations.
• Knowledge of insurance types, payer hierarchy, and coordination of benefits.
• Ability to work independently with minimal supervision, manage pressure, and meet deadlines.
• Computer literacy and proficiency with Microsoft Office (Excel required).
• Excellent communication skills for collaboration with internal teams and external partners.
• Ability to prioritize work and manage competing tasks.
• Understanding of HIPAA and handling of Protected Health Information (PHI).
• Critical thinking and problem-solving to identify root causes and corrective actions.

Responsibilities

• Manages multiple client accounts according to assigned volume and productivity expectations.
• Monitors and reports low volumes, missing dates of service, and encounters lacking required insurance or payer information.
• Uses RICA coding application and AthenaIDX to update and correct demographic records and resolve errors.
• Verifies and assigns accurate payer information to support timely billing with at least 95% accuracy.
• Takes ownership of Level 2 escalations from offshore team and provides feedback to supervisor.
• Processes work within 2 business days from when it becomes available; notifies supervisor if off track.
• Completes daily production records accurately and on time.
• Communicates deviations from workflows and escalates issues impacting submission or month-end close.
• Collaborates with Billing, Coding, Enrollment, EDI, Leadership as needed.
• Participates in ongoing training and process improvements to stay compliant with payer guidelines.
• Performs other related duties as assigned.

Skills

Attention to detail

Eligibility interpretation

HIPAA compliance

Communication

Microsoft Office (Excel)

Prioritization

Problem solving

Adaptability

Education

High School Diploma or GED

1 year in healthcare

Athena IDX experience

Insurance data entry / Medical front office training or certification

Tools

RICA coding application

AthenaIDX

Job description

Brault is seeking a detail‑oriented healthcare data specialist to review, verify, and fill missing registration/insurance information on encounters. You will apply payer requirements, update demographic records, and ensure accurate billing information.

The role supports multiple client accounts, works with RICA and AthenaIDX tools, and targets a 95% accuracy rate while adhering to company policies and timelines.