Description

Job Title: Eligibility Specialist - Behavioral Health

Classification: Full Time/ Non-Exempt

Reports to: Front Office Manager

Salary: $17.00 to $20.00

Summary:

This full-time role involves verifying insurance Eligibility and Benefits as well as requesting Referrals and Authorizations for patients seeking behavioral health care, liaising with insurance providers, and educating patients about their insurance benefits.

Responsibilities:

• Verify insurance eligibility and benefits for patients seeking behavioral health services, on an outpatient basis.
•  Liaise with insurance providers to obtain accurate and up-to-date information regarding coverage limits, claim procedures, and pre-authorization requirements.
• Educate patients and their families on their insurance benefits, coverage restrictions, and potential out-of-pocket costs.
• Assist in the admission process by ensuring all health center intake documentation is complete and accurate.
• Collaborate with healthcare providers, administrative staff, and external agencies to facilitate seamless care coordination.
• Maintain detailed records of insurance verifications and communications.
• Enter referral and authorization information appropriately into claims prior to filing.
• Stay informed about changes in insurance policies and regulations that impact behavioral health services.
• Handle sensitive information with confidentiality and in compliance with HlPAA regulations.

Additional Expectations:

• Learn and utilize eClinical Works EMR.
• Utilize various online resources for benefits investigation and referral requests.
• Serves as back up to front office and operator.
• All other duties as assigned.

Requirements

Qualifications/Experience

• Highschool diploma or equivalent; further education or certification in healthcare administration a plus.
• Minimum 1-2 years' experience in eligibility verification, preferably in a behavioral health setting.
• Understanding of insurance and the marketplace.
• Experience working in a clinic and/or social service organization.
•  Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers and other funding sources.
•  Excellent communication and interpersonal skills, with the ability to explain complex insurance details in a clear and empathetic manner.
•  Knowledge of mental health conditions and the specific requirements for insurance coverage for this modality of care.
• Bilingual

Time/Physical Requirements

• Monday-Friday, 8:00am-5:00pm/40 hours per week
• Some evening and weekend activities may require flexing schedules.
• Tasks occur in both medical office, clinic setting, and community.
• Able to lift 25lbs and perform normal duties associated in a clinic and office setting.