Insurance Eligibility Specialist

Job Summary

The Entry level Insurance Eligibility Specialist has experience verifying insurance coverage and will focus on maintaining accurate insurance records as a member of Indian Creek Foundation’s accounting department. In this role, you will manage insurance eligibility to ensure coverage for services while coordinating with families and covered individuals to track policy benefits and card renewals. The Insurance Eligibility Specialist is an organized and detail-oriented individual who is skilled at communicating clearly in both technical and layperson environments.

Basic Qualifications

Education/Training

High School diploma or equivalent business experience.

Experience

Entry level position with experience verifying insurance coverage and Microsoft Excel required. Experience checking insurance eligibility using Availity Essentials, Navinet, PEAR Portal, and/or PROMISe preferred. Nonprofit experience preferred.

Basic Skills

• Excellent written and oral communication skills
• Organizational and interpersonal skills
• Ability to work independently and collaboratively within a team environment
• Able to multi-task and meet deadlines
• Problem solving ability
• Ability to classify, assemble, analyze, and prepare reports from financial data
• Proficient in Electronic Health Record (EHR), Microsoft Excel, and other relevant software applications
  
  
  

Physical Requirements

• Bend, stoop, sit, stand, and reach
• Lift items weighing 50 pounds or less
• Satisfactory completion of post-offer pre-employment physical exam and drug test as required
  
  
  

Equipment/Machine Operations

Must maintain skills necessary to safely and efficiently operate the following equipment and machines used in the performance of this job:

• Computer
• Printer
• Copier
• Scanner
• Fax machine
• E-copy
• Card Scanner
• Various other equipment and supplies
  
  
  

Essential Duties

• Verify insurance for Behavioral Health Services (BHS). This includes identifying mental or behavioral health “carve outs” to other insurance plans.
• Assess eligibility for Intensive Behavioral Health Services (IBHS), Applied Behavioral Analysis (ABA), Outpatient, and Peer Support programs based on network status, procedure codes, etc. Gather necessary insurance information by making outbound phone calls and utilizing provider web portals and claims clearinghouse.
• Maintain accurate consumer insurance records by uploading information to our EHR software and maintaining spreadsheets for insurance tracking.
• Identify when insurance cards on file are no longer current and request new insurance cards from program staff as needed.
• Communicate with our consumers and their families about how to update Coordination of Benefits with insurance companies, including Pennsylvania Medical Assistance.
• Assist the BHS Billing team in reducing and resolving claim denials when due to insurance changes, plan termination, or COB issues.
• Coordinate and assist in special projects between Accounting and Behavioral Health Services department.
• Serve as backup for other accounting department functions as assigned
  
  
  

Other Duties

• Assist the Supervisor with various administrative tasks to support department operations as directed; may also be assigned special projects.
• Perform tasks which are supportive in nature to the essential functions of the job, but which may be altered or redesigned depending upon individual circumstances.
• Meet on-going training requirements to maintain current certifications.
  
  
  

Standard Requirements

• Completion and clearance of a criminal background check and a child abuse clearance.
• Supports the Mission and values of Indian Creek Foundation and the program.
• Is knowledgeable of resident rights and ensures an atmosphere which allows for the privacy, dignity, and well-being of all individuals served in a safe, secure environment.
• Supports, cooperates with, and implements specific procedures and programs for:
• Safety, including universal precautions and safe work practices, established fire/safety plans, report and/or correct unsafe working conditions, equipment repair, and maintenance needs.
• Confidentiality of all data, including individuals served, employee, and operations data.
• Compliance with all regulatory requirements and agency policies as required by Human Resources, licensing, and funding agencies.
• Demonstrate knowledge and compliance with HIPAA standards.
• Conducts oneself in a professional manner when representing Indian Creek Foundation.
• Functions as a member of the Team:
• Cooperates and works together with all co-workers, plans and complete job duties with minimal direct supervision and appropriate judgment.
• Uses tactful and appropriate communications in all situations.
• Reports and follows up regarding reported complaints, problems, and concerns with appropriate personnel.
• Promotes positive public relations with individuals served, family members, other team members, and community.
• Completes requirements for training, acceptable attendance, dress codes including personal hygiene and other work duties as assigned.
• Complete all documentation to ensure compliance with all regulations and agency policies.
• Exhibits behavior as set forth by the Code of Conduct in performance of their duties.
• Completes annual compliance HIPAA training and exhibits behavior as set forth by the Code of Compliance in performance of duties.
  
  

Job Location

Cowpath Road – main campus

Receipt and Acknowledgment

I acknowledge and understand that:

• Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind, and that my employment is at-will.
• The job description provides a general summary of the position in which I am employed, that the contents of this job description are job requirements, and at this time, I know of no limitations which would prevent me from performing these functions. I further understand that it is my responsibility to inform my supervisor at any time that I am unable to perform these functions.
• Job duties, tasks, work hours and work requirements may be changed at any time.
• Acceptable job performance includes completion of the job responsibilities as well as compliance with the policies, procedures, rules, and regulations.
  
  
  

I have read and understand this job description.