Healthcare Guest Eligibility Specialist I-Ohio
$45,760–$47,840 year
Remote · Arizona, United States or Texas, United States
Job Summary
Guest Eligibility Specialist I roles: verify insurance coverage and eligibility, review CPT/HCPCS/ ICD-10 codes, initiate and follow up on prior authorizations through payer portals, and fax requests. Responsible for collecting and entering required guest information, maintaining accurate medical records, and communicating with providers, sites, and payers. Responsibilities include tracking authorization statuses, identifying payer issues, researching denial reasons, submitting corrected authorizations and appeals, and ensuring compliance with HIPAA and organizational policies. Requires organizational skills, attention to detail, and proficiency with Excel; must have a high school diploma or equivalent and several years of registration/authorization experience. Remote work is allowed within specified states; onsite training and orientation are mandatory for new employees. Benefits include competitive health/dental/vision coverage, retirement plan with matching, and paid time off.
Required Qualifications
- High school diploma or equivalent
- 4+ years of registration and authorization experience
- Experience with Ohio Medicaid, Presumptive Eligibility, and obtaining insurance authorizations through payer portals
- Knowledge of CMS guidelines, contracted insurance guidelines and coding policies
- Strong written and communication skills
- Ability to maintain confidentiality (HIPAA)
- Ability to pass background checks and driving requirements if applicable
- Detail-oriented and organized
- Proficiency in Microsoft Excel
- Valid driver license (if driving is required)
- Experience with entering accurate demographic/insurance information into systems
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