The Patient Eligibility Specialist provides patient related services regarding enrollment and eligibility for various payers; assists patients in completing applications and qualifying for sliding fee discounts; coordinates with Medicaid case works to enable qualified clients to enroll in Medicaid or other appropriate public health programs; enters financial eligibility portion of Breast and Cervical enrollment package and verifies eligibility; researches patient questions regarding accounts/statements and initiates appropriate adjustments; provides practice management system “check out” function to all self pay patients and provides walk out bill, collects fees if appropriate and enters payment into practice management system.
Knowledge, Skills & Abilities
• Reads, speaks, understands and writes proficiently in English.
• Independent and self-directed.
• Works effectively in a team environment.
• Problem-solves with creativity and ingenuity.
• Organizes, prioritizes, and coordinates multiple activities and tasks.
• Works with initiative, energy and effectiveness in a fast-paced environment.
• Produces work in high quantity and quality.
• Remains calm and effective in high pressure and emergency situations.
• Use of multi-line telephones and other office machines.
• Keyboarding: 35 wpm with a 95% accuracy rate.
• Knowledge of medical terminology.
• Proficiency in the use of Microsoft Office applications; Word, Excel and Outlook.
• Knowledge of dental terminology.
• Bilingual skills.
• High school graduate or equivalent.
• Graduate of an accredited Medical Billing Certificate program.
• Customer service related experience working with the general public (1 year).
• Working with insurance/billing in a healthcare setting/insurance organization.
• ICD-9 coding experience.
• CPT-4 coding experience.
• CDT-5 coding experience.
• Healthcare information systems, such as electronic health record and practice management systems experience.
• Working with low income, multi-ethnic populations.
• Working with private and/or government third party reimbursement.
Job Specific Functions/Performance Expectations:
1. Verifies insurance coverage for next day’s schedule using practice management system appointment reports.
2. Provides information and assistance to patients regarding their eligibility for insurance programs and applications to specific health care plans.
3. Coordinates with Medicaid case workers to enable qualified clients to enroll in Medicaid or other appropriate public health programs.
4. Assists patients in completing applications and qualifying for sliding fee discounts.
5. Follows up on outstanding sliding fee applications and enters tracking data into sliding fee database.
6. Available to front desk for insurance confirmation of walk-ins during the day.
7. Enters financial eligibility portion of Breast and Cervical enrollment package and verifies eligibility.
8. Maintains Breast and Cervical Health Data Base to assure all necessary paperwork is completed.
9. Researches patient questions regarding accounts/statements and initiates appropriate adjustments.
10. Assists patients in setting up payment plans, completing payment plan contract and forwards to billing office.
11. Cross trained in all Patient Account Specialist and Patient Eligibility Specialist functions
Community Health Center of Snohomish County - 2 years ago
Community Health Center of Snohomish County (CHC) is a non-profit provider of primary medical, dental and pharmacy services. CHC was founded...