Eligibility Coordinator

Optim Orthopedics is seeking a full time Eligibility Coordinator for the Savannah location.

Summary
Responsible for coordination and oversight of ensuring all eligibility is active and benefits and authorizations reviewed prior to the patient being seen to ensure best practice workflow to capture clean claim submission and reduce back end denials and overall AR in the practice.

Essential Duties and Responsibilities

Reviews clinic schedules 48 hours in advance of appointment for designated locations and checks all eligibility and benefits to ensure patient insurance is active. Will be required to contact patient if there is an issue with their insurance in advance of the appointment.

Updates copay information in Athena and provides notes in the patient account for the front desk regarding co-insurance, deductibles due and collections of any balances due prior to patient’s appointment.

Monitors eligibility bucket in EMR for upcoming appointments. Reviews the patient’s insurance for eligibility and benefits.

Responsible for ongoing daily monitoring of EBT email group to assist Patient Access Coordinators with eligibility issues identified at the time of making the appointments.

Responsible for verifying that authorizations are obtained and attached to the appropriate appointment at the time of the visit to ensure claim is submitted correctly and accurately.

May assist Patient Account Coordinator as needed in setting up payment plans to help patients manage payment of bills.

May assist in identifying and communicate any trends, denial issues or irregularity impacting resolution of patient accounts or daily production workflow to supervisor and other team members and recommend resolution.

Must have a comprehensive understanding and knowledge of the insurance claim process, EOB and patient statement to assist patients as needed with questions.

Forwards any billing issues identified to the appropriate staff to assist patients with resolution.

Maintains up-to-date knowledge of third party billing and reimbursement, clinic’s financial policies and industry knowledge.

Must maintain accuracy in demographic and data entry in the EMR system.

Uses electronic systems (email, Practice Management System and EMR) for communication to other staff members to have an accurate detail account in the patient record. Maintains professional and respectful documentation at all times in the patient record.

Responds to patient calls timely and professional and documents appropriately in the patient chart.

Completes annual compliance and regulatory requirements as applicable. Follows all work processes, procedures while maintaining compliance to the organizations rules and regulations.

Protects and keeps all patient information confidential following all HIPAA, state and federal laws. Upholds and promotes patient safety and quality.

Accepts ownership for all tasks and responsibilities while improving the company’s reputation. Escalates any problems to the Manager or Supervisor as appropriate.

Demonstrates and encourages team behavior and exceptional patient/guest experiences.

May be required to serve as back up as needed for other Front Office positions for check in or check out.

Other duties may be assigned.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Competencies
To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Synthesizes complex or diverse information; collects and researches data; uses intuition and experience to complement data.

Continuous Learning - Seeks feedback to improve performance; pursues training and development opportunities; shares expertise with others.

Job Knowledge - Competent in required job skills and knowledge; exhibits ability to learn and apply new skills; keeps abreast of current developments; requires minimal supervision; displays understanding of how job relates to others; uses resources effectively.

Use of Technology - Demonstrates required skills; adapts to new technologies; troubleshoots technological problems; uses technology to increase productivity; keeps technical skills up to date.

Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics.

Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments.

Communications - Expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; exhibits good listening and comprehension; keeps others adequately informed; selects and uses appropriate communication methods.

Cooperation - Establishes and maintains effective relations; exhibits tact and consideration; offers assistance and support to co-workers; works cooperatively in group situations; works actively to resolve conflicts.

Managing Customer Focus - Promotes customer focus; establishes customer service standards; provides training in customer service delivery; monitors customer satisfaction; develops new approaches to meeting customer needs. Oral

Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions; demonstrates group presentation skills; participates in meetings.

Teamwork - Balances team and individual responsibilities; exhibits objectivity and openness to others' views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests.

Written Communication - Writes clearly and informatively.

Conflict Resolution - Encourages open communications; maintains objectivity.

Diversity - Shows respect and sensitivity for cultural differences.

Ethics - Treats people with respect; works with integrity and principles; upholds organizational values.

Organizational Support - Follows policies and procedures; completes administrative tasks correctly and on time.

Adaptability - Adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.

Consultative Selling - Builds rapport and establishes trust.

Achievement Focus - Measures self against standard of excellence.

Personal Appearance - Dresses appropriately for position; keeps self well groomed.

Attendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time.

Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; commits to long hours of work when necessary to reach goals.; completes tasks on time or notifies appropriate person with an alternate plan.

Initiative - Seeks increased responsibilities; asks for and offers help when needed.

Innovation - Displays original thinking and creativity; meets challenges with resourcefulness; generates suggestions for improving work.

Judgment - Exhibits sound and accurate judgment; makes timely decisions.

Quality - Demonstrates accuracy and thoroughness; monitors own work to ensure quality. Quantity - Meets productivity standards; completes work in timely manner; strives to increase productivity; works quickly.

Safety and Security - Observes safety and security procedures; reports potentially unsafe conditions; uses equipment and materials properly.

Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

High school diploma or general education degree (GED). Associate Degree desired.

Minimum two years of medical billing and/or eligibility experience. Knowledge of ICD-9, CPT, HCPCS and the use of modifiers preferred. Familiar with CMS 1500 claim form completion, knowledge of Medicare, Managed care and commercial insurance products and plans. Knowledge of physician billing and/or collections.

Typing speed 55 wpm and the ability to use a calculator.

Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Mathematical Skills

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentages.

Reasoning Ability

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Computer Skills

To perform this job successfully, an individual should be proficient in MS Word, Excel, and PowerPoint. General knowledge of technology is preferred.

Certificates, Licenses, Registrations

Certified Patient Account Representative (CPAR) preferred.

Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear and frequently required to stand, walk, sit, and use hands to handle files, computers, and phones; reach with hands and arms. Frequent and regular repetitive movements required using the wrists, hands, and/or fingers.

The employee will operate a keyboard, calculator, telephone, copy machine, computer and other office equipment as necessary. The employee frequently is required to move all extremities within full range of motion as well as stoop and bend at 90 degrees. The employee must occasionally lift and/or move up to 30 pounds.

It is necessary to view and type on computer screens for long periods of time and to work in an environment which can be very stressful. Specific vision abilities required by this job include close vision. This is a full time position. This position may require long hours.

Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate. Must be able to deal with aggressive, hostile and sometimes irrational behavior of patients and family members and have the ability to respond to all patients in a calm and professional manner.

Job Type: Full-time

Benefits:

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

Schedule:

• Monday to Friday

Work Location: In person