Eligibility Specialist (Administrative)
Job Title: Insurance Eligibility SpecialistDepartment: EligibilityReports To: SVP of Patient Care CoordinationPosition Type: Full-Time
GENERAL SUMMARY
The Insurance Eligibility Specialist is responsible for verifying patient insurance coverage and ensuring benefits are active and applicable for home health or hospice services to facilitate accurate billing and reimbursement. This position plays a critical role in preventing claim denials and delays by ensuring all insurance information is accurate and up to date prior to services being rendered.
ESSENTIAL DUTIES
Utilize telephone and online portals to verify insurance eligibility and benefits; communicate relevant information to appropriate departments regarding each patient's home health or hospice benefits.
Accurately document insurance information and benefit details in Homecare Homebase (HCHB).
Identify and communicate discrepancies or non-covered services to the appropriate team.
Occasionally contact patients to clarify insurance carrier and policy numbers.
Occasionally contact patients regarding workers' compensation claims, including gathering case manager contact information and settlement dates.
Maintain up-to-date knowledge of payer policies, healthcare regulations, and insurance updates.
Respond promptly to internal inquiries related to insurance coverage or eligibility.
Protect patient confidentiality and ensure compliance with HIPAA regulations.
Work weekends and holidays as needed.
Perform other duties as assigned.
SPECIAL SKILLS AND ABILITIES REQUIRED
Strong understanding of commercial insurance plans, Medicare, Medicaid, and managed care.
Excellent communication and customer service skills.
Proficiency with healthcare software systems and insurance portals.
High attention to detail and accuracy.
EDUCATION
High school diploma or GED required.
EXPERIENCE
Minimum of 1 year of experience in insurance verification, medical billing, or healthcare administration preferred.
CORE COMPETENCIES
Build credibility and trust
Collaborate with others
Demonstrate interpersonal understanding and utilize effective communication skills
Deliver results
Analyze problems and make sound decisions
Demonstrate resilience under pressure
Commit to continuous learning and improvement
DEGREE OF TRAVEL
None
