Eligibility Specialist I
2 weeks ago
Position Overview
The Eligibility Specialist is tasked with the monthly management of eligibility data files, alongside the necessary updates to the IDX system, which includes additions, modifications, and terminations. This role requires conducting thorough research and analysis on eligibility data.
The ideal candidate will possess experience in verifying eligibility through various health plan platforms, both online and via telephone communication.
Responsibilities include the verification of manual claims, electronic claims, and authorizations. Attention to detail in claims and authorizations is essential. A solid understanding of diverse product lines within the healthcare sector is also required.
Key Responsibilities
1. Retrieve and consolidate eligibility files from health plan platforms.
2. Upload eligibility data to the designated subsystem.
3. Update the system with necessary additions, modifications, and terminations.
4. Demonstrate knowledge of health plan websites and maintain effective communication with health plans.
5. Exhibit familiarity with HMO, Medicare, and medical product lines while collaborating with various departments.
6. Develop and manage spreadsheets in Excel, ensuring accuracy in verifying capitation discrepancies.
Required Qualifications
- A minimum of two (2) years of experience in the healthcare field.
- High School Diploma or GED is required.
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