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Senior Eligibility Verification and Benefit Coordinator
2 months ago
OneOncology is a leading provider of cancer care services, and we are seeking a highly skilled Sr. Eligibility Verification and Benefit Specialist to join our team.
Job Summary:The Sr. Eligibility Verification and Benefit Specialist will be responsible for verifying and maintaining insurance coverage for all patient accounts, ensuring that patients receive the necessary care and benefits. This role requires strong analytical and problem-solving skills, as well as excellent communication and customer service skills.
Key Responsibilities:- Verify and maintain insurance coverage for all patient accounts, including obtaining and monitoring referrals as needed.
- Communicate with patients and other departments regarding patient coverage and liability.
- Resolve all Eligibility and Coordination of Benefit Denials in Unity.
- Run daily reports to monitor and obtain authorizations and/or referrals required by the insurance carrier for patient visits.
- Verify and load existing patient insurance changes by completing an insurance verification form for each patient.
- Ensure referrals are in place for other teams to obtain the appropriate authorization.
- Reply to all instant messages with the Front Office related to patients changes of insurance, copay questions, coverage, and any process/procedure questions in a timely manner.
- Work all emails regarding coverage from all other teams.
- Work with the patient to ensure any coordination of benefits issues are handled according to policy and procedure to ensure appropriate and timely processing of claims.
- Work all insurance denials relating to patient insurance coverage, premium payment, pre-existing, and relays provider participation issues to the credentialing department.
- Enter all departmental copays and gather the ded/oop accumulations.
- Monitor Pending Cobra accounts to ensure policy is active and the patients claims will be processed and paid appropriately.
- Document all changes made to the account in the practice management system, providing detailed, accurate, and well-thought-out notes.
- Makes insurance changes, relating to research, transplant, SNF, Hospice in Practice Management system and EMR system documenting in the required templates in the patient's chart.
- Coordinates and communicates information required or requested by other teams within the mandated timeframe.
- Ensures up-to-date documentation on patient accounts on follow-up or ongoing transactions.
- Works any eligibility payer denials to ensure claims can be paid timely, including reaching out to the patient, insurance, and possibly the employer.
- Works any Coordination of Benefit denials to ensure claims are paid timely and correctly, including reaching out to the patient, insurance, and possibly the employer.
- Follows policy and procedures outlined by management to ensure standardization of processes.
- Notifies Eligibility Verification and Benefit Management of any issues that potential for a negative outcome for the organization.
- High School diploma or equivalent.
- One year experience in a directly related role preferred, but not required.
- Must be willing and able to lift up to 25 pounds.
- Must be willing and able to travel to satellite clinics when necessary.
- Attendance is an essential job function.
- Ability to work effectively with all levels of management and other colleagues.
- Ability to demonstrate initiative and mature judgment.
- Ability to demonstrate high degree of professionalism and adaptability.
- Ability to demonstrate proficiency in the use of end-user computer applications (MS work, Excel, Outlook), database, and patient scheduling and other medical information systems.
- Ability to demonstrate strong customer service delivery skills.
- Ability to utilize websites, portal, and electronic options when available to increase efficiency.
- Ability to follow oral and written instructions.
- Ability to recognize and solve problems using creative thinking skills, hands-on problem-solving skills, and the ability to analyze and respond to data.
- Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
- Skilled at multi-tasking, organizational skills, and superb attention to detail.
- Working knowledge of Hospice and other payer requirements.
- Knowledge of clinic office procedures, medical practice, and medical terminology.
