Patient Eligibility Specialist

US Oncology Inc.; New Providence, Northern (NJ, KY); Hybrid; USD 25,000 - 49,000; Full time

Job summary

Prism Vision Group in New Providence, NJ, is seeking an Insurance Verification Specialist for an on-site role at our New Providence CBO location.

You will verify benefits, coordinate appointments, manage charts, and secure financial clearance to support patient care.

The role emphasizes HIPAA compliance, confidentiality, and teamwork within a fast-paced office environment.

Qualifications

• 1+ years of experience in medical services, insurance plans, revenue cycle, or a combination thereof.
• Familiarity with Practice Management systems.
• High School Diploma or GED required.

Responsibilities

• Verify patient insurance details to ensure eligibility and reimbursement.
• Coordinate appointments and verify appropriate appointment types.
• Prepare and review electronic medical charts.
• Gather and verify patient demographics and insurance information for financial clearance.
• Inform patients about benefits, referrals, and out-of-pocket responsibilities.
• Manage prior authorizations and communications with carriers.
• Maintain patient confidentiality and HIPAA compliance.
• Support ad-hoc projects as needed.

Skills

Communication

Analytical thinking

Teamwork

Confidentiality

Adaptability

Education

High School Diploma or GED

Tools

Microsoft Office (Excel)

EMR systems

Practice Management systems

Job description

This is a non-exempt on-site role, located at our New Providence CBO location and is part of Prism Vision Group.

Compensation Range: $18-$35.50/hr (Dependent on Experience)

ROLE AND RESPONSIBILITIES

• Insurance Verification: Confirm patient insurance details, including detailed benefits and referrals, to ensure eligibility and secure financial reimbursement ahead of service delivery.
• Appointment Coordination: Analyze patient information to verify the appropriateness of appointment types, employing analytical skills for optimal scheduling.
• Chart Management: Prepare and review electronic medical charts, understanding minimal clinical requirements to match treatments with diagnoses.
• Financial Clearance: Accurately gather and verify all patient demographic, financial, and insurance information, ensuring comprehensive financial clearance. This includes obtaining necessary referrals, authorizations, and pre-certifications to mitigate denials and secure reimbursement.
• Patient Communication: Inform patients/guarantors about their benefits, authorization needs, and out-of-pocket responsibilities, including co-pays, deductibles, and co‑insurance.
• Prior Authorization: Efficiently manage prior authorization demands, including reviewing patient diagnoses, communicating with insurance carriers, and utilizing insurance portals for submission.
• Compliance and Communication: Maintain patient confidentiality, contribute positively to team dynamics, and engage in continuous professional development through meetings and seminars.
• Maintain a high level of confidentiality regarding legal matters, privacy issues and data integrity.
• Other duties as assigned. Aids with ad‑hoc, special projects, as needed.

POSITION QUALIFICATIONS

• Education: High School Diploma or GED required.
• Experience: 1+ years of experience and knowledge in medical services profession, insurance plans, revenue cycle, or a combination of all. Familiarity with Practice Management systems.

KNOWLEDGE/SKILLS/ABILITIES

• Accountability – Ability to accept responsibility and account for his/her actions and work performed. Willing to accept constructive feedback.
• Accuracy – Ability to perform work accurately and thoroughly with attention to all details of a project or task.
• Adaptability – Ability to adapt to and facilitate change in the workplace.
• Communication – Ability to communicate effectively with others using good listening skills.
• Empathetic – Ability to appreciate and be sensitive to the feelings of patients and co‑workers.
• Initiative – Ability to make decisions and take actions to solve a problem or reach a goal. Desire to excel, attempting non-routine tasks.
• Judgment – Ability to make sound decisions using available information.
• Reliability – Can be relied upon to demonstrate reliability in attendance and punctuality.
• Team Player – The ability to work with others and independently for a common goal. Puts aside own individual needs to work toward the larger group objective and reinforces the contribution of others.
• Prior healthcare experience
• Insurance Knowledge: Familiarity with insurance referral and reimbursement criteria.
• Communication: Exceptional verbal and written communication skills.
• Analytical Proficiency: Strong critical thinking, analytical, and problem-solving abilities, coupled with excellent patient care orientation.
• Excellent interpersonal skills and ability to work effectively with physicians, co-workers, other departments and patients of all ages, and from across a broad range of cultural and social economic backgrounds.
• Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in accordance with established policies and HIPAA regulations.
• Demeanor: Personable, outgoing, and friendly, fostering positive interactions and relationships.
• Work Ethic: Demonstrates flexibility and adaptability, capable of thriving independently and as an integral part of a team in dynamic environments.
• Self-Management: Ability to work independently in a fast-paced environment, maintaining professionalism and confidentiality in line with HIPAA regulations.
• Technical Skills: High proficiency in Microsoft Office Suite, especially Excel, and the ability to navigate and master various electronic systems.
• Computer Proficiency, Microsoft Office to include Word, Excel, Power Point

WORK ENVIRONMENT

An office environment with a controlled atmosphere.