What are the responsibilities and job description for the Eligibility Specialist - Remote position at Pacific Cardiovascular Associates?
Job Description
Job Description
Job Summary :
The Eligibility Specialist is responsible for verifying accurate patient eligibility for various third-party commercial insurances, Medicare and CalOptima to ensure proper reimbursements. The Eligibility Specialist provides administrative support with a willingness to work closely with patients, physicians, and other members of the health care team. Must be professional, detail-oriented, have exceptional customer service skills, and be able to handle a very fast-paced environment.
This role is currently remote, with occasional in-office meetings as needed. We value flexibility and will communicate any future changes well in advance to ensure a smooth transition.
Responsibilities :
- Secures sufficient coverage information to confirm dates of eligibility.
- Updates the EMR system with appropriate eligibility and benefit information to include co-pays where applicable.
- Updates patient demographics as needed.
- Position requires long periods of time on the phone and payer portals with insurance carries, patients and internal staff.
- Coordinates with and assists the Authorization Coordinators as needed.
- Handles all errors made by auth coordinators by communicating directly with them.
- Handles all questions from auth coordinators.
- Assist hospital schedules with issues / questions.
- Assist Clinic with issues / questions.
- Instrumental in training auth coordinators new to PCA as well as training new processes / workflows
- Attend meetings to assist with implementing new processes in authorization workflows
- Assist schedulers with auth questions & issues
- Handles most outside calls coming in regarding authorizations
- Reviews and obtains auth for CPET
- Determines if auth is necessary for testing non-established patients
- Regularly monitors auth coordinators inboxes to ensure tasks are worked timely
Required Skills / Abilities :
Education and Experience :
Physical Requirements :
Pay Range : $21.00 - $23.00 per hour
Salary : $21 - $23