Medical Insurance / Eligibility Coordinator

As a Insurance and Eligibility Coordinator you’ll be responsible for; Heavy data entry; Calling multiple Health Plans to obtain members medical coverage and benefits. Verify Insurance Eligibility monthly. Heavy attention to detail.

REQUIRED EDUCATION/TRAINING/PROFESSIONAL EXPERIENCE –

• High School degree or equivalent G.E.D required
• Knowledge of Microsoft Word, Excel; ability to work with multiple information systems
• Knowledge of medical and pharmaceutical terminology (ICD-10, J-codes)
• Pharmacy or medical office experience preferred
• HMO, PPO, Medicare Insurance knowledge
• 45 wpm

EXPECTED PROFESSIONAL COMPETENCIES:

• General knowledge of pharmacy and healthcare laws and regulations
• Engages in appropriate continuing professional development
• Practices patient centered care
• Practices professionally
• Practices legally
• Practices ethically
• Decision making skills
• Team working skills
• Communication skills
• Strong Problem Solving skills
• Customer Service skills
• Detail oriented

ROLES AND RESPONSIBILITIES –

• Obtain members medical benefits in detail along with risk, copay and/or co-insurance information.
• Create physician profile in computer systems, demographics
• Keep current and compliant with statutes, rules and regulations related to pharmacy
• Participate in continuous improvement and quality assurance programs
• Input insurance information, pharmacy and medical
• Resolve aspects of specialty pharmacy and medical including Medicare, Medicaid, PBM, PPO and IPA and communicate with payers and advise patients or physician of results when needed.
• Communicate with various pharmacy departments as needed to coordinate timely prescription adjudication to meet schedules.
• If necessary, contact physician offices
• Report errors, omissions or incidents to pharmacists
• Participate in quality program initiatives and improvement activities
• Comply with all regulatory requirements, including HIPAA/HITECH
• Other responsibilities as assigned by Management

PHYSICAL DEMANDS:

Frequent immobility and/or sitting required for extended periods of time. Some bending and stooping required. Requires manual dexterity to operate keyboard, calculator, photocopy machine, and other office equipment. Requires eyesight correctable to 20/20 to read reports and computer terminals. Requires hearing within normal range for telephone use. Occasional high stress work.

WORK ENVIRONMENT:

Normal office environment.

Experience:

• Medical Assistants with Insurance Verification Knowledge are Encouraged to apply
• Medical Office Experience: (Preferred but not Required)

Job Type: Full-time

Job Type: Full-time

Pay: $20.00 - $22.50 per hour

Benefits:

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

Experience:

• Insurance verification: 1 year (Preferred)

Language:

• English (Required)

Work Location: In person

Salary : $20 - $23