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Overview-
As a key contributor to clinical and revenue cycle operations, a Patient Eligibility Specialist plays a pivotal role in managing patient information, verifying patient treatment eligibility through meticulous insurance processes, and supporting patient care through the accurate preparation of medical charts. This role demands a dynamic individual capable of navigating complex insurance systems and contributing positively to team dynamics.
Insurance Verification: Confirm patient insurance details, including detailed benefits and referrals, to ensure eligibility and secure financial reimbursement ahead of service delivery.
Appointment Coordination: Analyze patient information to verify the appropriateness of appointment types, employing analytical skills for optimal scheduling.
Chart Management: Prepare and review electronic medical charts, understanding minimal clinical requirements to match treatments with diagnoses.
Financial Clearance: Accurately gather and verify all patient demographic, financial, and insurance information, ensuring comprehensive financial clearance. This includes obtaining necessary referrals, authorizations, and pre-certifications to mitigate denials and secure reimbursement.
Patient Communication: Inform patients/guarantors about their benefits, authorization needs, and out-of-pocket responsibilities, including co-pays, deductibles, and co- insurance.
Prior Authorization: Efficiently manage prior authorization demands, including reviewing patient diagnoses, communicating with insurance carriers, and utilizing insurance portals for submission.
Compliance and Communication: Maintain patient confidentiality, contribute positively to team dynamics, and engage in continuous professional development through meetings and seminars.
Advanced proficiency in Microsoft Office Suite, particularly Excel, is essential for successful job performance.
Education: High School Diploma or GED required. Experience in healthcare administration.
Full Time
$44k-53k (estimate)
05/10/2024
07/10/2024
prismvisiongroup.com
Union, NJ
The job skills required for Patient Eligibility Specialist include Coordination, Confidentiality, Patient Care, HIPAA, Written Communication, Microsoft Office, etc. Having related job skills and expertise will give you an advantage when applying to be a Patient Eligibility Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Patient Eligibility Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Patient Eligibility Specialist positions, which can be used as a reference in future career path planning. As a Patient Eligibility Specialist, it can be promoted into senior positions as a Patient Accounts Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Patient Eligibility Specialist. You can explore the career advancement for a Patient Eligibility Specialist below and select your interested title to get hiring information.