Benefits Eligibility Specialist

The Benefits Verification Specialist will contact insurance companies, on behalf of the physician’s office, to verify patient specific benefits. The Benefits Verification Specialist will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefits coverage. Cross trains in other front end insurance verification process.

Responsibilities/Essential Functions (other duties as assigned):

· Verify all new, returning, and annual patient eligibility to confirm insurance status and benefits including patient responsibility such as deductible, out of pocket, copay and coinsurance prior to services rendered.

· Verify if any prior authorizations are required pre-treatment such as HMO or PCP authorizations initiating authorization request and confirming with the office staff once received

· Utilize online insurance portals, phone communication and other eligibility tools in order to obtain accurate verifications and submit authorization requests based on verified authorization requirements

· Coordinate with Financial Counselor, Patient Navigator and front office staff to ensure smooth collection process.

· Maintains appropriate documentation in clinic systems and EMR.

· Communicate with patients, front end staff, physicians & payors as needed in order to obtain updated insurance and/or clinical information

· Operate compliantly at all times by keeping patient data secure and confidential and adhering to all company policies and procedures

· Maintain excellent customer service and kindness with all patients and staff

· Regular attendance and punctuality.

· Execute all functions of the role with positivity and team effort by ensuring that all processing and reporting deadlines are consistently achieved.

· Perform any other functions as required by management

Education:

· High school diploma or GED minimally required. Two (2) years directly related and progressively responsible experience and/or college degree.

· Specific administration, benefit verification, coding, claims processing or customer service at an insurance company a plus

· Broader experience/training may be considered in fields such as case management, social services and pharmacy technician.

· Familiarity with verification of insurance benefits a plus.

· Fundamental understanding of key payers including Medicaid, Medicare and private payers

· Strong customer service experience

Job Type: Full-time

Pay: $20.95 - $21.34 per hour

Schedule:

• Monday to Friday

Ability to Commute:

• Fresno, CA 93720 (Required)

Ability to Relocate:

• Fresno, CA 93720: Relocate before starting work (Required)

Work Location: Hybrid remote in Fresno, CA 93720

Salary : $21 - $21