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Patient Eligibility Specialist

2 months ago

Tempe, Arizona, United States NextCare Full time
Job Overview

Current Opportunities Available in Specific Counties

About NextCare

NextCare is dedicated to being a frontrunner in accessible healthcare, providing urgent care, occupational health, virtual health, and primary care services. With a presence in twelve states and over 170 urgent care facilities, we are committed to delivering exceptional and affordable healthcare services nationwide.

Our core values of caring, growth, integrity, results, and teamwork are integral to our operations. These principles guide our interactions with patients, customers, investors, partners, and each other. Our high-performance standards are essential for making informed clinical and business decisions, reflecting our commitment to quality and service in high-access healthcare.

Position Summary

The role of the Eligibility Specialist involves the assessment, execution, and oversight of claims that have been rejected or denied concerning patient eligibility. Key responsibilities include generating daily reports, formulating a training strategy, and collaborating with Revenue Cycle Leaders, Clinic Leaders, Front Office Staff, and Educational Departments. The specialist will communicate current billing guidelines, update clinic insurance resources, and report to the Billing Manager and Senior Vice President of Revenue Cycle. Additionally, the role focuses on identifying and resolving billing challenges prior to claim submissions to insurance providers, aiming to minimize upfront denials, prevent aging accounts receivable, and reduce days sales outstanding (DSO).


Key Responsibilities:

  • Exhibit strong technical and data management capabilities along with a collaborative mindset.
  • Experience in processing eligibility inquiries for member benefits using Payer Websites and Clearinghouses.
  • Act as a liaison between the Business Office and Clinical Teams.
  • Collaborate closely with all management levels from Headquarters to Clinical Teams.
  • Proficient in training clinical teams on patient eligibility inquiries.
  • Respond to inquiries via phone and messaging platforms.
  • Provide training and support to management and clinical staff on eligibility processes and patient benefits determination.
  • Create and maintain eligibility processes and guidelines.
  • Participate in leadership meetings focused on claim denials and rejections.
  • Demonstrate self-motivation.
  • Assist the Billing and Collections Supervisor with inquiries.
  • Work with management to enhance billing procedures based on denial types.
  • Contribute to the creation and presentation of eligibility reports.
  • Identify trends in eligibility-related denials and rejections, developing corrective action plans and training.
  • Assist in training new team members on eligibility submission and benefits determination.
  • Perform additional duties as assigned in accordance with company policy.
  • Uphold the NextCare Mission Statement, Vision, Values, and Performance Standards in all interactions.


Essential Qualifications:

Education: High School Diploma or equivalent required.

Experience:

  • A minimum of four years in billing, collections, and accounts receivable management.
  • Familiarity with Managed Care, Medicare, and Medicaid Programs.
  • Proficient in Microsoft Office Suite: Word, Excel, Teams.
  • Experience with patient insurance eligibility, including:
    • Determining patient benefits.
    • Calculating patient copayments.

Skills: Excellent verbal and written communication skills, with the ability to work independently.

Preferred Skills:

  • Experience with Nextgen PM / EHR.
  • Familiarity with Waystar Clearinghouse.
  • Knowledge of Payer Provider Portals.
  • Understanding of basic medical billing terminology.

Benefits:

NextCare provides full-time employees with a comprehensive benefits package, including medical, health savings accounts, dental, vision, life insurance, long-term and short-term disability, employee assistance programs, and paid time off. All employees are eligible for 401(k) Plan benefits, with additional shift differential benefits available for select positions. Benefits are provided in accordance with company policy and plan rules.

Equal Opportunity Statement