Benefits and Eligibility Professional

Job Summary

The Benefits & Eligibility Professional is responsible for verifying patient insurance coverage, determining out-of-pocket costs, and creating accurate patient estimates for medical services. This role involves direct communication with patients to explain their benefits, answer coverage-related questions, and provide financial counseling. The specialist ensures transparency in patient financial responsibility and supports a smooth billing and revenue cycle process.

Qualifications

• 3-5 years of experience working in a hospital, doctor’s office, or billing setting
• Have working knowledge of CPT codes and Diagnostic Codes
• Working knowledge of co-pay and out of pocket expenses from an insurance perspective
• 1 or more years of experience working in a medical or healthcare environment required
• 3-5 years procedure and/or medication authorization experience required
• Calling patients and insurance benefits and eligibility understanding
• EPIC experience required
• Microsoft Office Suite (Excel, Word, and Outlook) and Internet
• Ability to handle confidential and sensitive information
• Ability to have working knowledge of medical terminology and are familiar with insurance and hospital billing policies and procedures.
• Strong attention to detail, problem-solving abilities, and ability to manage multiple tasks in a fast-paced environment.
• Excellent communication and customer service skills with the ability to explain complex insurance details to patients.

Responsibilities

• Verify patient insurance coverage, eligibility, and benefits for medical services, procedures, and treatments.
• Contact insurance companies to confirm copays, deductibles, out-of-pocket costs, and coverage limitations.
• Generate and provide detailed patient cost estimates based on insurance benefits and contracted rates.
• Communicate with patients via phone, email, or in-person to discuss their insurance benefits and financial responsibility.
• Explain coverage details, pre-authorization requirements, and potential out-of-pocket expenses in a clear and professional manner.
• Address patient questions regarding their insurance coverage, prior authorizations, and billing inquiries.
• Document all insurance verifications, patient estimates, and communications in the electronic health record (EHR) system.
• Collaborate with financial counselors, billing departments, and clinical teams to ensure patients are well-informed about their coverage.
• Assist patients with payment plan options and financial assistance programs as needed.
• Stay updated on payer policies, benefit structures, and changes in insurance coverage requirements.

Work Environment/Physical Demands/Travel Requirements

• The role may involve working under pressure to meet tight deadlines
• Travel: None
• Primarily sedentary, using a computer and phone very often

Job Type: Full-time

Pay: $15.00 - $20.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• Do you have EPIC experience ?
• Do you have experience Calling patients?
• Do you have experience with insurance benefits and eligibility?

Ability to Commute:

• Louisville, KY 40202 (Required)

Work Location: In person

Salary : $15 - $20