Eligibility Specialist (Contract)
$41,600–$41,600 year
Remote
Job Summary
Verify patient insurance coverage, benefits, and eligibility using AthenaHealth and payer portals while obtaining and tracking required pre-authorizations. Identify primary and secondary coverage to coordinate benefits and prevent claim denials, then notify patients of discrepancies with clear guidance. Maintain accurate documentation of verification outcomes and conduct follow-ups on pending items to prevent billing delays. Collaborate with billing specialists and the Operations team to resolve eligibility issues, claim holds, and maintain the proprietary insurance-provider mapping database. Ensure patient information is correctly recorded for accurate billing and reimbursement.
Required Qualifications
- Minimum of 2 years of experience in medical billing, front office, insurance verification, or eligibility-related roles
- Proficient with AthenaHealth or another EHR, insurance payer portals and other eligibility verification systems
- Must have eligibility experience with major commercial plans, across multiple states in a telehealth model
- Must be authorized to work in the United States without current or future sponsorship needs
Desired Qualifications
- Strong verbal and written communication skills, with the ability to explain complex insurance details to patients and internal team members
- Proven ability to investigate, resolve, and prevent issues related to insurance verification and eligibility
- High degree of accuracy in verifying patient data and maintaining records
- Ability to thrive in a fast-paced, growing environment, while maintaining a focus on patient satisfaction and operational excellence
- Organized and detail-oriented professional with a deep understanding of insurance policies and coverage verification
- Strong communication skills and problem-solving abilities
- Adaptable, proactive, and capable of managing multiple tasks while ensuring the accuracy and integrity of patient information
- Focus on teamwork and patient care
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