Eligibility Specialist

3 weeks ago

Imperial, California, United States Sasha Salloum Md, Inc. Full time
Eligibility Specialist Job Description

Sasha Salloum Md, Inc. is seeking a highly skilled Eligibility Specialist to join our team. As an Eligibility Specialist, you will play a critical role in ensuring that patients receive the medical services they need while also ensuring that healthcare providers are properly reimbursed for their services.

Key Responsibilities:
  • Verify Patient Insurance Coverage: You will be responsible for verifying patient insurance coverage, including benefits, deductibles, and co-pays. This may involve contacting insurance companies to obtain information about patient coverage and eligibility.
  • Determine Patient Eligibility: Based on insurance coverage and other factors, you will determine whether patients are eligible for specific medical services. You may need to work closely with physicians and other medical staff to make these determinations.
  • Authorize Medical Services: You will be responsible for authorizing medical services, including diagnostic tests, procedures, and treatments. This may involve working with insurance companies to obtain authorization for certain services.
  • Billing and Coding: You will ensure that medical services are billed correctly, which may involve coding medical procedures, submitting claims to insurance companies, and following up on unpaid claims.
  • Patient Education: You may also be responsible for providing patients with information about their insurance coverage, benefits, and eligibility for medical services. You will need to explain complex insurance policies and procedures to patients in a clear and concise manner.
  • Record Keeping: You will be responsible for maintaining accurate records of patient insurance coverage, eligibility determinations, and authorizations for medical services.
Requirements and Skills:
  • Proven work experience as a Patient Service Representative or similar role
  • Knowledge of medical terms and practices
  • Professional manner and appearance
  • Strong interpersonal and communication skills
  • Meticulous attention to detail
  • E-clinical works experience
  • Proficient in Microsoft Office Suite (Word, Excel, Outlook, and Access)
  • High school diploma or equivalent preferred

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