Insurance Eligibility Specialist
2 weeks ago
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.
- 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.
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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