Eligibility Referral Specialist

1 month ago

Ridge, United States New York Cancer & Blood Specialists Full time
Eligibility Referral Specialist
Ridge, NY

At New York Cancer & Blood Specialists (NYCBS), we foster an environment where passionate professionals thrive. Our 200+ oncologists, hematologists, and staff across 25 locations are united by a mission: redefining what's possible against cancer and blood disorders. With cutting-edge treatments, groundbreaking research, and a patient-first philosophy, we're innovators reshaping modern medicine. Join our rapidly growing organization serving over 50,000 patients annually and unlock new frontiers in healing and hope.

In this role, you will:
  • Verify insurance benefits including primary, secondary, and tertiary. Obtain all pertinent information of out-of-pocket, co-insurance, deductible, co-pay, and if referrals/authorization are required for services.
  • Update systems (both OncoEMR and practice management Centricity) of any insurance changes that are made. Verify newly entered benefits into the practice management system. Work with front staff to obtain new insurance cards and demographics every 3 months.
  • Obtain referrals for office visits, labs, radiology, and chemotherapy and radiation therapy.
  • Run daily business office activity reports to work the Referral required and Insurance Issue statuses. This report will be run several times daily. All patients must be approved by the end of the day. Any patients who do not have a completed status by 3 pm EST must be reviewed with the manager to determine if the appointment should be rescheduled.
  • Work daily Visit Owner: NYCS Eligibility (Commercial) & NYCS - Referral. All tickets must be touched and/or worked within 24-48 hours. Appropriate visit descriptions are required to be listed, core notes added, and follow-up performed promptly.
  • Coordination of Benefit (COB) letters are to be mailed to patients when phone contact (3x) has been unsuccessful. The sent letter must be documented in the patient's chart.
  • Answer calls from insurance and patients on questions for claims and/or patient balance.
  • Review and explain the patient's statements and their financial responsibility. Work account as necessary and/or set up a signed payment plan with the patient.
  • Refer to the Financial Counselor if the patient balance is for treatment with drugs and possibly needs patient assistance.
  • Work closely with third-party vendor Fedora to ensure authorizations are in place and insurance benefits are accurate.
  • Obtain referrals/authorizations for any add-on on treatment the same day.
  • Maintain and ensure the confidentiality of all patient and employee information at all times.
  • An eligibility referral specialist will be expected to work when given sufficient notice of required overtime.
We require:
  • High School diploma
  • Experience working in the healthcare field, preferably in a clinical setting or business office
  • Experience in insurance requirements and medical terminology ICD-10 and CPT coding
  • Excellent oral and written communication skills
  • Ability to accept direction and work within a team concept
  • Possession of typing and computer skills an asset
  • Strong customer service skills.
  • Previous experience an asset

Hours: Monday-Friday
Salary up to $26 an hour based on experience and. Potential for discretionary bonus.
Benefits include Tuition Reimbursement, Health Insurance on day 1 of employment, Dental, Vision, Life Insurance, Short and Long-term disability, 401k Plan, generous PTO time, 8 paid holidays (2 floating), and more.

Visit our website at: nycancer.com and follow us on Facebook
NYCBS is an Equal Opportunity Employer

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