Eligibility Specialist

About Us

Since 1974, Associated Retina Consultants has an experienced team of Arizona eye specialists to diagnose and treat your vision problem. Our focus is on the retina, macula, and the vitreous humor in the eye. We work hard every day to protect and save our patients vision, helping them lead better quality lives.

Position Summary:

We are looking for an organized, efficient Eligibility Specialist is to effectively investigate benefits and eligibility with various insurance plans. This team member will have the right skills to thoroughly research and identify the critical details our patients need to know to make informed decisions regarding their care. This person has a positive attitude, is detail-oriented, a strong multi-tasker, and reliable. You will have that unique ability to build relationships with team members, insurance representatives, and patients, both in-person and over the telephone.

Responsibilities:

• Accurately verify benefits and eligibility to ensure that our patients can make informed decisions in regards to the cost associated with their healthcare plan.
• Research, review, and effectively document benefits and eligibility within our systems.
• Effectively communicate verification information both internally and externally to ensure that coverage is in place and claims are paying accurately.
• Validates demographic/insurance information entered in the system by staff is accurate and completed on a timely basis.
• Obtains needed authorizations for services requested with assistance from location staff, as needed, in a timely and accurate manner.
• Reconciles eligibility/insurance coverage discrepancies.
• Identifies and resolves problems with participant eligibility/insurance coverage.
• Must possess good interpersonal and communication skills both verbally and in writing including knowledge of basic grammar, spelling & punctuation.
• Requires the ability to read, write and speak effectively in English.
• Critical thinking skills are strongly preferred.
• Must be able to handle multiple tasks simultaneously.
• Performs other duties as assigned.

Education and Experience:

• High school diploma or equivalent, associate degree preferred.
• Minimum of 1-2 years of insurance verification, referrals, prior authorization, or eligibility experience required experience preferred.
• Knowledge of general healthcare billing practices is preferred.
• Knowledge of Microsoft Office Suite, specifically with Excel (spreadsheets).
• Ability to handle sensitive and confidential information.
• Ability to interact with all levels of staff, external providers, and customers.

Skills:

• Planning and Organizing
• Data Entry
• Attention to detail, accuracy, and efficiency
• Problem-Solving
• Teamwork
• Multitasking
• Customer Service
• Electronic Medical Records (EMR)
• Communication skills - verbal and written
• Integrity

Benefits: Paid Medical, Dental, Vision, Life Insurance, Disability Insurance, 9 Paid Holidays, Vacation and Sick Time, and much more.

Physical Requirements:

• Prolonged periods sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

An in-office environment with a controlled atmosphere. Possible exposure to staff or patients with communicable diseases and blood-borne pathogens.

The Company has reviewed this job description to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employees ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and the Company reserves the right to change this job description and/or assign tasks for the employee to perform, as the Company may deem appropriate.

Associated Retina Consultants is an Equal Opportunity Employer.