Guest Eligibility Specialist

Job Summary

To support the operations in Ohio and Delaware, the part-time Guest Eligibility Specialist I will verify insurance coverage, review clinical documentation, and manage authorization processes remotely while ensuring accurate data entry and compliance with healthcare regulations.

Key responsibilities

• Verify insurance coverage and eligibility, ensuring accurate documentation
• Review procedure orders to determine the necessity of prior authorization and follow up on submitted authorizations
• Maintain accurate patient medical records and provide feedback on project status to relevant departments

Required qualifications

• High school diploma or equivalent
• 4+ years of registration and authorization experience required
• Working knowledge of CMS guidelines, contracted insurance guidelines, and coding policies
• Intermediate to Advanced proficiency in Microsoft Excel
• Ability to maintain a high level of confidentiality in accordance with HIPAA guidelines