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Healthcare Eligibility Specialist

2 months ago

Atlanta, Georgia, United States MultiPlan Full time

Overview: Envision a professional environment that empowers you to analyze, innovate, and motivate. Our team members contribute significantly by assisting healthcare payers in managing care costs, enhancing competitiveness, and driving positive transformations. Become part of a well-established organization with a 40-year history dedicated to helping our clients succeed through tailored healthcare cost management solutions.

Diversity and Inclusion: Our commitment to diversity, inclusion, and belonging is woven into the very fabric of our organization. We aim to cultivate a workplace that promotes mutual respect and collaboration, allowing every talented individual to engage and excel in their roles. At MultiPlan, we are a community where exceptional individuals thrive.

Role Responsibilities:

1. Conduct a substantial volume of outbound calls, manage document imaging, and perform data entry tasks.
2. Utilize various tools to research contact information.
3. Implement Coordination of Benefits (COB) rules to establish the correct order of benefits.
4. Initiate and manage files within the home application system.
5. Develop and maintain tracking reports.
6. Collect claim overpayment details from healthcare providers.
7. Execute searches within insurance claim databases.
8. Pursue overpayments and initiate the refund process for identified overpayments.
9. Collaborate and communicate effectively across different disciplines and departments.
10. Ensure adherence to HIPAA regulations and standards.
11. Exemplify the company's core competencies and values.
12. Please note that due to exposure to sensitive data, this role is classified as high risk.
13. The responsibilities outlined above are not exhaustive; additional duties and qualifications may be assigned as necessary.

Job Scope:

Prioritize the needs of both external and internal customers when making decisions and taking actions. Engage in communication with clients, members, and their employers. Manage personal workload with attention to detail, employing creative problem-solving skills to review, research, and update file information. Deliver high-quality results and remain open to feedback, teamwork, and contributing ideas for process improvement. Decision-making is guided by established protocols and may require escalation to a supervisor.

Compensation: The salary range for this position is $19.50 per hour. Specific offers will consider the candidate's education, experience, skills, work location, and internal equity. This position also offers eligibility for health insurance, a 401k plan, and bonus opportunities.