Eligibility Specialist

3 weeks ago

Lafayette, United States SCP Health Full time
Description

Responsible for accurately resolving registration and eligibility edits, related to the demographic and/or insurance information, based on departmental policies and procedures and feedback received from various payors. Assist chart flow through the PreBilling processes and maintain inventory levels to ensure timely, effective, and accurate chart processing while maximizing revenue.

Responsibilities:
  • Update demographics and/or insurance information based on feedback provided by internal or payor edits, using available resources: face sheets, insurance cards, eligibility results etc.
  • Determine the appropriate insurance carrier and billing information from the data contained in the patients medical record and use that information to accurately update a patients account in the billing system
  • When insufficient or questionable data is supplied in the medical record, contact the appropriate insurance carrier or facility to acquire accurate data
  • Utilize the Eligibility process/data in Centricity or on the payors websites to obtain more accurate information on each patient returned with an edit
  • Request additional insurance company entries in Centricity when necessary
  • Request direction and clarification from supervisor or lead when necessary, in order to assure accurate resolution of edits
  • Identify and work complex edits presented from various sources
  • Identify and report results of user and/or system issues that impact billing quality
  • Maintain understanding of current departmental policies and procedures
  • Promote a team environment that will support the growth of every department member and achievement of all department goals as a result of team work
  • Actively participate in meetings and educational programs in an effort to improve both individual and team quality and effectiveness
Knowledge, Skills and Abilities:
  • Detail oriented and organized
  • Self-motivated; capable of compiling/tracking data to meet deadlines and goals
  • Excellent interpersonal skills
  • Ability to work equally well individually and in a team environment
  • Professional attitude and demeanor
  • Written and oral communication skills
  • Proficient computer knowledge of Word, Excel, Windows and Outlook
  • Quick learner with an aptitude for custom computer systems
  • Previous success and comfort with entering data for extended time periods and limited interruptions
  • Contact insurances via phone call for complex edits

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