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. Responsibilities
- 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.
Skills and Abilities
- Insurance Knowledge: Familiarity with insurance referral and reimbursement criteria.
- Communication: Exceptional verbal and written communication skills.
- Analytical Proficiency: Strong critical thinking, analytical, and problem-solving abilities, coupled with excellent patient care orientation.
- Excellent interpersonal skills and ability to work effectively with physicians, co-workers, other departments and patients of all ages, and from across a broad range of cultural and social economic backgrounds.
- Ability to show tolerance and sensitivity in stressful situations and safeguard confidential information in accordance with established policies and HIPAA regulations.
- Demeanor: Personable, outgoing, and friendly, fostering positive interactions and relationships.
- Work Ethic: Demonstrates flexibility and adaptability, capable of thriving independently and as an integral part of a team in dynamic environments.
- Self-Management: Ability to work independently in a fast-paced environment, maintaining professionalism and confidentiality in line with HIPAA regulations.
- Technical Skills: High proficiency in Microsoft Office Suite, especially Excel, and the ability to navigate and master various electronic systems.
Motivations
- Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
- Growth Opportunities: Inspired to perform well by the chance to take on more responsibility
Computer Skills
- Advanced proficiency in Microsoft Office Suite, particularly Excel, is essential for successful job performance.
Qualifications
- Education: High School Diploma or GED required. Experience in healthcare administration.
At PRISM Vision Group, we believe great work deserves great rewards. Here's what you can expect when you join our team:
- Competitive Compensation – Base salary, performance bonuses, and regular reviews.
- Health & Wellness – Comprehensive medical , dental, and vision insurance; and wellness program.
- Retirement Planning – 401(k) with company match.
- Generous Time Off – Paid vacation, sick leave, and company holidays.
- Learning & Development –career growth programs.
- Other Perks – Commuter benefits, Voluntary Accident and Critical Illness plans, FSA/HSA and Dependent Care FSA. employee discounts, and more.
Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.