Eligibility Specialist

Job Summary

A company is looking for an Eligibility Specialist to improve mental healthcare access by managing eligibility processes.

Key Responsibilities

• Verify patient eligibility and benefits using clearinghouses and payer portals to ensure accurate claims submission
• Investigate and resolve eligibility-related denials by researching coverage details and correcting discrepancies
• Draft appeals for claim denials and ensure patient data is accurate and up to date

Required Qualifications

• At least 2 years of experience in Medical Billing or a healthcare setting
• Strong understanding of healthcare claims, plan benefits, and patient responsibilities
• Experience with CMS 1500 forms and knowledge of data, coding, and policy errors
• Highly organized and process-driven with the ability to prioritize workflows
• Ability to adapt to a fast-paced environment with changing priorities