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Eligibility Analyst

3 months ago

Tempe, United States NextCare Full time
Job DescriptionJob Description

Consideing applicants in Maricopa and Pinal counties only at this time.

NextCare Introduction

NextCare strives to be the leader in high access healthcare, offering urgent care, occupational health, virtual health and primary care services to our patients. With offering services in twelve states (Arizona, Colorado, Kansas, Michigan, Missouri, New Mexico, Nebraska, North Carolina, Oklahoma, Texas, Virginia and Wyoming) and over 170 urgent care clinic locations, we offer exceptional, affordable care to patients across the country.

At NextCare, we constantly strive to provide you with the highest degree of caring, growth, integrity, results and teamwork. These essential core values form the foundation of our relationships with patients, customers, investors, partners and one another. Extraordinarily high-performance standards serve as critical guides for making important clinical and business decisions. The expression of these standards is evident in our behavior, our attitude, and our approach to our daily work. The product of our strict adherence to core values is the ability to harness tremendous organizational energy to achieve our goal of upholding the highest standard for quality and service within the high access healthcare. This unique combination of values, performance standards and commitment serves as the key to our success.

Location

Join our team in Tempe, AZ

  • Hybrid Opportunity- Onsite at HQ two days a week in Tempe, AZ
  • Schedule Monday thru Friday; Training 8:00AM to 5:00PM
  • Up to 10% travel in Arizona

POSITION SUMMARY: This position involves reviewing, implementing, and managing rejected and denied claims related to patient eligibility. Responsibilities include generating daily reports, developing a training plan, and implementing it with Revenue Cycle Leaders, Clinic Leaders, Front Office Staff, and Education Departments. The Eligibility Analyst will disseminate current billing guidelines, update clinic insurance resources, and report to the Billing Manager and Sr. VP of Revenue Cycle. Additionally, they will help identify and resolve billing issues before claims are submitted to insurance carriers, aiming to reduce the number of upfront denials, prevent accounts receivable from aging, and decrease days sales outstanding (DSO).


ESSENTIAL FUNCTIONS:

  • Have strong technical and data management skills, and a collaborative spirit.
  • Background in processing eligibility inquiries for member benefits utilizing Payer Websites and Clearinghouses.
  • Liaison between the Business Office and Clinical Teams
  • Work Closely with All Members of Management from Headquarters to Clinical Teams
  • Highly adept at training our clinical teams on patient eligibility inquiries
  • Responds to questions, telephone calls, and Teams Messenger App.
  • Trains and assists management and clinical staff on Eligibility Processes, and how to determine patient benefits.
  • Keep create and/or maintain Eligibility Processes and Tips
  • Attend Leadership Meetings Regarding Claim Denials and Rejections.
  • Self-Starter
  • Assist the Billing and Collections Supervisor fielding questions
  • Work with management to streamline billing procedures based on denial types
  • Assist with creating and presenting reports on eligibility
  • Identify trends in eligibility related denials and rejections and develop plans for correction and training
  • Assist with the training of new team members on how to submit, determine patient eligibility and benefits
  • Performs other related duties as assigned or described in Company policy.
  • Treats patients and co-workers consistent with the NextCare Mission Statement, Vision, Values and Performance Standards.
  • Performs other related duties as assigned or described in Company policy.


ESSENTIAL SKILLS AND EXPERIENCE: Education: Minimum of High School Diploma or equivalent.

Experience:

  • Must have a minimum of four years' experience in billing, collections, and general accounts receivable management.
  • Experience with Managed Care, Medicare and Medicaid Programs.
  • Microsoft Experience: Word, Excel, Teams, PC
  • Patient Insurance Eligibility
    • Determining Patient Benefits
    • Determining Patient Copayments

Skills: Excellent verbal and written communication skills and be able to work independently

VALUED BUT NOT REQUIRED SKILLS AND EXPERIENCE:

  • Nextgen PM / EHR
  • Waystar Clearinghouse
  • Payer Provider Portals
  • Basic Terminology of Medical Billing Practices

Benefits:

NextCare offers full time employees medical, health savings account, NextCare employee visit program, dental, vision, basic life, voluntary employee/spouse/child life, long term disability, short term disability, employee assistance program, critical illness, accident, legal, identity theft and paid time off benefits. Employees of all statuses are offered 401(k) Plan benefits. Employees in select positions are offered shift differential benefits. Benefits are offered per policy and plan rules.

Equal Opportunity Statement