Insurance Eligibility Specialist

2 weeks ago


Oakland, New Jersey, United States CardioOne Full time
About the Company

CardioOne collaborates with independent cardiologists to deliver innovative solutions aimed at enhancing patient outcomes while minimizing costs. Our value-driven cardiology care offerings empower our physician partners to excel in the transition to value-based care. CardioOne fosters an exceptional work environment, favorable working conditions, and competitive compensation.

We are committed to cultivating a culture of employee engagement that translates into an outstanding patient experience.

About the Role

Our expanding cardiology practice is in search of a dedicated individual to fill the role of Eligibility and Prior Authorizations Specialist. In this capacity, you will collaborate closely with a multidisciplinary team of healthcare professionals to confirm insurance eligibility and secure prior authorizations for medical procedures. You will report directly to the Practice Manager.

Schedule: Full-time, Monday through Friday, 7:30 AM to 4:30 PM.

Compensation: $19 per hour, based on experience.

Benefits: Medical, Dental, Vision, Paid Time Off

Key Responsibilities:
  • Verify patient insurance eligibility and assess policy coverage to ensure accurate patient accounts in the electronic health record (EHR) system.
  • Identify deductibles, co-payments, and co-insurance for patients enrolled in participating insurance plans.
  • Confirm active insurance coverage for patient appointments; update accounts with inactive insurance and communicate with patients for necessary information.
  • Collect payments including co-pays, co-insurances, deductibles, and prior balances from patients.
  • Assist with appointment scheduling and referrals between departments, serving as a liaison with participating insurance plans and patients.
  • Review patient chart documentation to ensure adherence to medical policy guidelines.
  • Obtain authorizations through EHR systems, payer websites, or phone calls, and diligently follow up on pending cases.
  • Maintain updated payer files to comply with authorization requirements and initiate appeals for denied authorizations.
  • Address clinic inquiries regarding payer medical policy guidelines and verify the accuracy of CPT and ICD-10 codes in procedure orders.
  • Contact patients to discuss eligibility and authorization statuses.
  • Schedule procedures at outpatient facilities and secure necessary authorizations.
  • Perform additional duties as assigned.
Qualifications:
  • Strong understanding of insurance verification and procedure authorization processes affecting revenue cycles.
  • Familiarity with payer medical policy guidelines for effective eligibility and authorization management.
  • Experience with EHR systems such as Athena, EPIC, or ECW (Athena is a plus).
  • Basic knowledge of human anatomy and medical terminology.
  • Proficiency in using CPT and ICD-10 codes.
  • Excellent computer skills, including MS Excel, Word, and Internet navigation.
  • Detail-oriented with exceptional organizational skills.
  • Ability to prioritize tasks effectively to meet deadlines.
  • Outstanding customer service skills with clear and effective communication abilities.
  • Capacity to multitask and maintain focus in a high-volume, time-sensitive work environment.
Work Location:
This position is based in an office environment.

Additional Information
Full-time hourly rate of $19 (commensurate with experience) plus medical, dental, and vision benefits.

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