Benefits Eligibility Specialist

Description

JOB SUMMARY: The Benefits Eligibility Specialist is responsible for verifying insurance eligibility and benefits, addressing insurance related patient concerns, providing Federal Funded Programs to include but not limited (Ryan White & SAMSHA, etc.), other PIHC services and completing required eligibility with clients who qualify, advise patients of their financial obligations. Benefits Eligibility Specialist also provide variety of Front Office administrative duties, including but not limited to answering and directing phone calls, greeting patients, collecting copayments, maintaining patient accounts by obtaining, recording, and updating personal and financial information.

This position description should not be interpreted as all inclusive. It is intended to identify the major responsibilities and requirements of this position. The incumbents may be requested to perform job-related responsibilities and tasks other than those stated in this position description.

Requirements

ESSENTIAL FUNCTIONS:

Duties and Responsibilities

• Verify insurance on scheduled patients to ensure eligibility and benefits are effective in order for accurate timely claim submission and payment. 
• Process intake forms and verify insurance benefits and or financial obligation for all new clients.
• Utilizes the online eligibility verification system, and/or may have to contact Payer directly via telephone, and/or access payer website.
• Assists client with any health care plan questions, concerns or issues to ensure that any problems are identified and necessary corrections are made in time to prevent or minimize delays in the client receiving coverage.
• Communicate with patient regarding patient’s insurance benefits, financial responsibility per sliding fee schedule, and to ensure Front Office is able to collect moneys such as copays.
• Educate clients regarding all financial and insurance benefits, government funds, grant, and drug reimbursement programs. Ensure all requirements are met.
• Must have experience with all payer types: Commercial, Medicare, Medicaid, HMO, etc.
• Collects all supporting documentation for Federal funded services eligibility and ensure that all documentation is uploaded in the system.
• Call and ensure that clients receiving Federal funded services are aware of the dates/times that the certifications are scheduled and ensure that clients are reminded of the documentation required of them for certification/eligibility. 
• Complete Ryan White annual certification processes to ensure that clients are eligible to receive services
• Assist patient in managing the sliding fee scale and determining annual cap on charges as required by Ryan White program
• Ensure that Release of Information (ROI), HIPPA and Patient Consent are obtained on all patients, updated as needed and scanned in the patient’s Electronic Medical Record (EMR).
• Fax all medical records requests and follow-up to ensure receipt of requested records.
• Performs all other related duties as assigned.

Minimum Qualifications

1. College degree preferred and minimum 1 to 2 year experience in Healthcare Customer Services, Insurance verification, and /or experience in providing Federal funded services. 
2. Experience in medical records and /or medical data entry required.
3. With minimum high school diploma or GED Equivalent and one year of clerical experience in a medical environment. 

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 this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit and talk or hear. The employee is occasionally required to walk, use hands to finger, handle, or operate computers, objects, tools, or controls and reach with hands and arms.

The employee must occasionally lift and/or move up to 30 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

NOTES:

1. Positive Impact Health Centers, Inc., is an equal opportunity employer and does not discriminate against any employee or applicant for employment because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, or covered veteran status.
2. Recreational drugs, weapons and violence are not permitted on agency property or at any agency events or programs.
3. The above job description represents the general nature, primary duties and responsibilities, and qualifications for the work performed by employees within this job, but is not a comprehensive and exhaustive list. Employees may be required to perform other duties as assigned, and specific duties, responsibilities, and activities within the core nature of the job may change at any time with or without notice. Employees must be able to perform the essential functions of the job, as specified by the employing entity, with or without reasonable accommodation.