LittleStar ABA is dedicated to providing quality care to our patients, and we are looking for a compassionate and experienced Eligibility Specialist who wants to grow with our company. The successful candidate will be responsible for maintaining eligibilities for all patients of companies LittleStar partners with. Key factors include assertively supporting LittleStar’s mission by keeping up with patients’ eligibilities to be able to receive ABA and other therapy services.

Condition of Employment:

· Must successfully pass the initial and updated criminal history, background, and record checks, which includes driving history checks.

· Must wear appropriate Personal Protective Equipment (PPE), as provided by LittleStar, where physical distance cannot be attained.

Essential Duties and Responsibilities for LittleStar ABA Therapy:

· Oversees the accumulation, transmission and dissemination of member information including the eligibility processes.

· Assist members in their responsibility to maintain Medicaid eligibility. Organize information and troubleshoots issues related to the Medicaid eligibility and enrollment process.

· Checks Medicaid eligibilities twice a month and notifies appropriate staff for any loss in coverage, changes to healthcare policies.

· Assigned eligibility checks from Diagnostic, Social Skills Group, and Intake teams.

· Checks all patients’ eligibilities at the beginning of each year.

· Spends most of the day on the phone calling to verify eligibility for patients.

· Detail orientated able to investigate and find answers.

· Corresponds with providers, staff, and network provider relations staff to coordinate/confirm network provider participation; communicates provider enrollment information and status.

· Builds and maintains relationships that nurture insurance provider partnerships.

· Maintains the stability and reputation of LittleStar ABA by complying with legal requirements

· Contributes to team effort by accomplishing related results as needed.

· Maintain confidentiality of center fiscal information.

· Maintain client confidentiality per LittleStar ABA policy and HIPAA Privacy Rule Regulations.

· Act as a positive role model for all staff, families and children working with LittleStar ABA and model a high standard of reliability, accuracy, integrity, and professionalism.

· Work to positively impact team spirit and overall morale

· Adhere to all LS policies and procedures

· Perform other duties as assigned by supervisors

Third-Party Billing Company Responsibilities:

· Oversees the accumulation, transmission and dissemination of member information including the eligibility processes.

· Assist members in their responsibility to maintain Medicaid eligibility. Organize information and troubleshoots issues related to the Medicaid eligibility and enrollment process.

· Checks Medicaid eligibilities twice a month and notifies appropriate staff for any loss in coverage, changes to healthcare policies.

· Assigned Eligibility Checks from Intake teams.

· Checks all patients’ eligibilities at the beginning of each year.

· Detail orientated, and able to investigate and find answers.

· Corresponds with providers, staff, and network provider relations staff to coordinate/confirm network provider participation; communicates provider enrollment information and status directly to outside companies in a professional manner.

· Builds and maintains relationships that nurture insurance provider partnerships.

· Perform other duties as assigned by supervisors

Educational Qualifications and Skills:

· High School diploma or GED required; Bachelor’s degree or equivalent years of experience preferred

· 1-2 years’ experience with insurance in a medical office setting required

· Strong understanding of medical terminology.

· Results and deadline driven

· Strong attention to detail

· Excellent time management and organizational skills

· Technology competent, including Microsoft Office, email and Internet

· A positive team player and energetic professional

· Strong organizational habits with attention to detail and accuracy

· Good time management skills along with the ability to manage multiple tasks

· Ability to analyze/solve problems and work in a fast-paced environment

· Strong communication skills with ability to communicate appropriately given the circumstances of the situation and audience involved

· Discretion in matters that need to remain private

· Ability to work with a variety of people, both internal and external

Supervisory Responsibility

This position has no supervisory responsibilities.

Work Environment

Position operates in a professional office environment. This role routinely uses standard office and audiovisual equipment. Position is eligible for telecommuting up to 60% of the time.

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 the job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk, climb stairs, use hands to finger, handle or feel; and reach with hands and arms. Must be able to lift up to 25 pounds.

Reasonable accommodations can be provided to assist or enable qualified individuals with disabilities to perform the essential functions of the position, upon request.

Travel

Travel is generally not required for this position but may occur occasionally to satellite centers, trainings or conferences as needed.