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Eligibility Specialist

2 months ago

Downers Grove, Illinois, United States Medix Full time
Job Summary

Medix is seeking an Eligibility Specialist to join our team in ensuring seamless member experiences. As an Eligibility Specialist, you will play a critical role in managing membership eligibility for Blue Cross Blue Shield members.

Key Responsibilities
  • Membership Eligibility Management: Verify and maintain accurate membership eligibility information for all Blue Cross Blue Shield members. Ensure that all data is current and aligns with company and insurance policies.
  • Correspondence and Communication: Prepare and distribute member correspondence, including termination letters, welcome letters, and physician change letters. Ensure all communications are accurate, timely, and adhere to organizational standards.
  • Provider Assignments and Notifications: Coordinate provider assignments and notifications, including pre-assignments for doctors and verification of patient coverage. Notify patients of any changes to their assigned healthcare providers.
  • Interdepartmental Communication: Serve as a communication bridge between various departments within the organization and the patients. Ensure that all parties are well-informed and up-to-date regarding eligibility, provider changes, and coverage details.
  • Record Keeping and Compliance: Maintain accurate and organized records of all member eligibility verifications, provider changes, and patient communications. Ensure compliance with all regulatory requirements and organizational policies.