Eligibility Specialist II

21 hours ago

Newburgh, United States The US Oncology Network Full time
Overview

The US Oncology Network believes local cancer care is better care and in 2017 Vantage Oncology joined The US Oncology Network. The US Oncology Network empowers the delivery of advanced integrated cancer care through our network of independent physicians who share expertise and resources to provide quality, value-based care close to home. Our clinical and business support capabilities, expertise and industry-leading technologies keep local practices at the forefront of high quality, efficient care delivery while enabling practice success, quality of life and financial security for physicians.

We have an immediate opening for a Full time Eligibility Specialist II.

SCOPE: Under general supervision, is responsible for the successful resubmission of invoices to the responsible party. Analyzes and resolves eligibility variances via web research and/or direct contact with patients. Coordinates the activities for the acquisition of referrals and retro authorizations, where applicable. Follows standard procedures and pre-established guidelines to complete tasks. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards, and US Oncology's Shared Values.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Researches and obtain accurate and current insurance coverage information, makes corresponding corrections in the PMS.
  • May evaluate benefits and eligibility to assess patient financial responsibility.
  • May coordinates referral from primary care clinic to ensure appropriate authorizations are secured and entered into the PMS.
  • Identifies uninsured patients and refers to patient benefit representative for coordination of payment.
  • Communicates system issues and/or payor trends lead or supervisor.
  • May answer questions and resolve complaints.
  • Documents conversations with payors in the PMS.
  • Contacts and follows up with clinic or any missing or incomplete documentation.
  • Works ETM and TES edits.
  • Manages complex payor eligibility and referrals.
  • Researches and responds to routine account inquiries and takes appropriate action; escalates non-routine issues, makes recommendations for solutions to unique situations.
  • Identifies processes and procedures to improve efficiencies.
  • Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records and collections.
  • Other duties as requested or assigned
Qualifications

MINIMUM QUALIFICATIONS:
  • High school diploma or equivalent required.
  • Associates degree preferred.
  • Position requires three (3) years with front desk, registrations, healthcare benefits or equivalent experience.
  • Proficiency with computer systems and Microsoft Office (Word and Excel) required.


PHYISICAL DEMANDS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations will be offered to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.

WORK ENVIRONMENT:The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations, and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.

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