Insurance Eligibility and Medical Billing Specialist

Job Summary:
The Eligibility & Medical Billing Specialist reviews patient accounts, verifies insurance coverage, identifies billable insurance, and helps determine whether balances should be billed to insurance, returned to the provider, or pursued as patient responsibility.

Primary Responsibilities

• Verify patient insurance eligibility using Office Ally and payer portals.
• Check coverage for specific dates of service.
• Review commercial insurance, Medicare, Medicaid, Medicare Advantage, and secondary coverage.
• Identify payer mismatches, terminated coverage, coordination of benefits issues, and possible rebilling opportunities.
• Document eligibility findings clearly in the collection system.
• Review accounts before patient collection activity when insurance may be available.
• Communicate with providers, billing departments, and internal collection staff.
• Assist with claim status checks when needed.
• Flag accounts that should be returned for billing review, corrected claims, appeals, or secondary billing.
• Maintain HIPAA-compliant handling of PHI and account documentation.

Success Measures

• Eligibility checks completed accurately and timely.
• Insurance-found accounts properly flagged before collection.
• Fewer accounts pursued incorrectly as patient responsibility.
• Clear documentation supporting collection or rebilling decisions.
• Improved recovery through insurance identification and rebilling opportunities.

Requirements:

• 1 year of medical billing, insurance verification, revenue cycle, or patient account experience.
• Familiarity with eligibility checks, payer portals, and insurance terminology.
• High School diploma or General Education Development (GED) required
• Understanding of deductibles, copays, coinsurance, primary/secondary insurance, COB, Medicare, Medicaid, and managed care plans.
• Ability to read and interpret eligibility responses.
• Strong attention to detail and accurate documentation.
• Comfortable working high-volume account queues.
• HIPAA awareness and professionalism with patient information.

Preferred Qualifications

• Experience with Office Ally.
• Healthcare collections or AR follow-up experience.
• Knowledge of claim status, denials, EOBs, ERAs, and patient responsibility.
• Experience with hospital, physician, ambulance, behavioral health, or specialty billing.
• Familiarity with Tennessee Medicaid / TennCare, Medicare, and commercial payer portals.

Physical Requirements:

• Ability to work a minimum of 40 hours per week/5 days a week.
• Hours are 40 hours per week during company’s regular business hours however evening and weekend work may be required as job duties demand.
• Work is in a typical office environment; prolonged sitting required (1-2 hours at a time); ability to move around the office to retrieve files, attend meetings in other areas, etc.; lifting/moving up to 50 lbs occasionally.

Salary : $20 - $24