Eligibility Specialist

3 weeks ago


Phoenix, United States Recruiting Firm Full time

Job Description Job Description Are you a detail-oriented problem solver with a passion for helping others? Do you thrive in fast-paced environments and possess the analytical skills to navigate complex applications and procedures? If so, a career as an Eligibility Specialist might be the perfect fit for youIn this vital role, you'll be the gatekeeper of critical programs, ensuring those who need assistance receive the support they deserve:ResponsibilitiesReview and analyze patient demographics, insurance information, and medical history to determine eligibility for healthcare services and coverage.Verify insurance benefits, copays, deductibles, and pre-authorization requirements.Communicate eligibility decisions to patients and healthcare providers clearly and concisely.Maintain accurate and up-to-date patient eligibility records in electronic systems.Stay current on healthcare policies, regulations, and payer rules within assigned areas of responsibility.Communicate effectively with patients, healthcare providers, insurers, and other stakeholders to resolve eligibility issues.Explain complex eligibility concepts in a clear and understandable manner.Investigate and resolve discrepancies in patient information or insurance coverage.Maintain a professional and courteous demeanor when dealing with challenging situations.Process incoming referrals for eligibility determination efficiently and accurately.Enter and maintain accurate data in electronic systems.Generate reports on eligibility activities and trends.Contribute to quality improvement initiatives related to eligibility processes.RequirementsA High School diploma or GED-1.5 Years in related experienceAssociate in medical or behavioral healthPrevious AZ HEAplus experience- RequiredAssociates/bachelor s degree in healthcare field- PreferredExperience in a health care setting- PreferredCustomer service experience is valued.Must possess good communication skills.Must have a valid Arizona Fingerprint Clearance card or apply for an Arizona fingerprint clearance card (Level 1) within 7 working days of assuming role.Must pass background check, TB test, Education verification and other pre-employment screening.#J-18808-Ljbffr

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