Healthcare Eligibility Specialist
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Job Description
Part-time remote healthcare eligibility specialist verifying insurance benefits for Pinnacle Home Care’s home health patients. Resolving coverage issues and documenting payer information.
Responsibilities:
- Verify patient insurance eligibility and benefits for new, returning, and existing patients.
- Review and resolve insurance eligibility issues in WellSky and other applicable systems.
- Process and update insurance changes, payer information, and demographic or coverage information.
- Document coverage dates, insurance details, copayments, deductibles, coinsurance, limitations, requirements, and out-of-network considerations.
- Communicate eligibility changes, discrepancies, and coverage concerns to branches and internal departments.
- Identify and escalate issues affecting patient services, authorizations, billing, or reimbursement.
- Collaborate with the Eligibility Team Lead and Authorization Manager on complex eligibility matters and payer requirements.
- Communicate with patients, insurance companies, payer representatives, branch personnel, and internal departments.
- Respond to eligibility-related inquiries and resolve discrepancies or account issues.
- Maintain complete eligibility verification documentation and monitor assigned accounts.
- Meet productivity, accuracy, quality, and turnaround-time expectations.
- Protect confidential patient information and comply with HIPAA and applicable regulations.
- Participate in training, staff meetings, quality initiatives, and process-improvement activities.
Requirements:
- High school diploma or GED required.
- Minimum of one (1) year of healthcare, medical billing, insurance verification, eligibility, or related experience required.
- Experience verifying insurance eligibility and benefits preferred.
- Experience in home health or another healthcare setting preferred.
- Experience working with electronic medical records and payer portals preferred.
- Previous experience with Medicare, Medicaid, managed care, commercial insurance, or other healthcare payer systems preferred.
- Previous home health experience preferred.
- Experience with WellSky or similar healthcare information systems preferred.
- Knowledge of insurance eligibility, benefits, deductibles, copayments, coinsurance, and coverage limitations preferred.
- Ability to work Saturdays and Sundays in 8-hour shifts from 8:30 AM–5:00 PM Eastern Time, with a Monday start.
- Ability to comply with HIPAA, privacy, security, regulatory, attendance, and company requirements.
Benefits:
- Personalized, One-on-One Care: Help patients heal and regain their independence by delivering individualized care in the comfort of their homes.
- Free Continuing Education Units (CEUs) to support licensure and career advancement.
- Employee referral program where you can earn rewards.
- Flexible scheduling.
- Supportive and collaborative team culture.
- Equal opportunity and inclusive workplace.
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