What are the responsibilities and job description for the Eligibility Specialist position at PIH Health?
Job Description
The primary responsibility of this position is to facilitate the treatment authorization process for managed care patients (Medicare, HMO and PPO). Performs clerical duties as required by PIH Health Rehab to meet the needs of the patient and facilitating the delivery of care. Works under general supervision and is responsible for the coordination of patient eligibility and referrals, to include submission, tracking, patient scheduling, and closing the loop on all referrals as well as the coordination of treatment for hospital and / or ancillary services. Entails communicating with Office.
PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women's health, urgent care and emergency services. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation's top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology. For more information, visit PIHHealth.org or follow us on Facebook, Twitter, or Instagram.
Required Skills
- Excellent organizational, written, and verbal communications and strong interpersonal skills
- Communicate effectively with staff, patients, guarantors, insurance companies, and physicians.
- Demonstrates attention to detail
- Good English speaking, spelling, reading, and mathematical skills required
- Must possess excellent telephone etiquette, and customer service skills.
- Proficient computer skills and knowledge in Word, Excel, Outlook, and ability to maneuver through multiple screens in a timely manner
- Ability to sort & file material correctly by alphabetic or numeric systems; computer data entry skills; ability to work effectively in fast-paced situations & tight deadlines
- Ability to stay on task in a fast and high-pressured environment
- Strict adherence to all HIPAA laws
- Strong commitment to customer service with demonstrated ability to create a positive patient experience
- Demonstrates the ability to work well independently as well as part of a team
- Understanding of guidelines for commercial, senior, and Medi-Cal requirements to expedite the treatment authorization process
- Ability to develop effective working relationships with all levels of the organization, physician offices and health plans
Required Experience
Required :
Preferred :
