Eligibility Specialist

Description

Job Title: Eligibility Specialist

Department: Patient Access

Reports To: Eligibility Supervisor

Job Grade: 2

Summary of Responsibilities

At UHS, Eligibility Specialists are responsible for communicating with insurers, employers and/or patients in order to ensure the accuracy of all claim data in an efficient manner that results an expeditious flow of work throughout the Patient Access area.

• Determine eligibility, maintain and complete data requirements for all claim records, demonstrating efficiency and the desire to produce results.
• Documentation of claim information through the use of multiple systems and online resources with a high level of accuracy.
• Troubleshoot and resolve claim records with missing or inadequate information by using analytical thinking skills.
• Establishes rapport and credibility with contacts by providing excellent customer service in a professional and respectful manner.
• Promptly handles escalated claims to ensure short turn-around times in other departments by understanding the “bigger picture” and valuing teamwork.
• Adheres to all HIPAA/state/federal guidelines for communication regarding patient health information (PHI).

Requirements

Required Qualifications, Skills, Knowledge:

• High school diploma. College degree is not required, but some college preferred.
• Knowledge of Windows, Power Point, Word and Excel or similar programs required.
• Strong keyboarding skills – fast and accurate 50 WPM with a 97% accuracy
• Investigative, curious and problem-solving mindset with the ability to multi-task
• Mature, patient, and able to appropriately handle difficult situations
• Able to handle high workload volume timely and accurately
• Must have a cheerful, pleasant disposition and enthusiasm for the position
• Excellent data entry skills and an above average attention to detail
• Able to work independently. Must be reliable and a self-starter.
• Salary commensurate with experience