Patient Eligibility & Benefits Navigator

OneOncology; Nashville (TN); On-site; USD 42,000 - 54,000; Full time

Job summary

OneOncology is seeking an Eligibility Verification and Benefit Specialist to verify new patients entering the Practice Management system and identify any benefits issues. The role involves reviewing electronic verification data, flagging at-risk accounts, and coordinating referrals for patient appointments to support the physicians and care teams.

Responsibilities include documenting coverage in the EMR, informing staff of insurance changes, and staying current on payer requirements to minimize

Qualifications

• High School diploma or equivalent.
• One year experience in a directly related role preferred, but not required.
• Ability to use MS Word, Excel, Outlook for daily tasks.
• Strong customer service and communication skills.
• Attention to detail and ability to multi-task.

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 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

Skills

MS Word

Excel

Outlook

Customer service

Communication

Problem solving

Attention to detail

Education

High School diploma or equivalent

Job description

OneOncology is seeking an Eligibility Verification and Benefit Specialist to verify new patients entering the Practice Management system and identify any benefits issues. The role involves reviewing electronic verification data, flagging at-risk accounts, and coordinating referrals for patient appointments to support the physicians and care teams.

Responsibilities include documenting coverage in the EMR, informing staff of insurance changes, and staying current on payer requirements to minimize