Eligibility and Benefits Specialist

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🌵 Arizona, Florida, +10 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🥔 Idaho – Remote ⚜️ Louisiana – Remote 🗻 New Hampshire – Remote 🌲 North Carolina – Remote 🏰 Missouri – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote

💵 $47k - $52k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👩‍👩‍👧‍👦 Human Resources (HR)

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Connecting for Better Health

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2021

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Connecting for Better Health is a nonprofit coalition dedicated to improving health and social service data sharing in California. The organization brings together providers, caregivers, health plans, advocates, and community organizations to collaborate on enhancing data sharing policies. Their initiative promotes the Data Exchange Framework (DxF), which aims to facilitate secure and efficient exchanges of health and social services information to support better whole-person care.

📋 Description

• Verify patient insurance eligibility, benefits, authorization requirements, and referral needs prior to services. • Obtain referrals from primary care providers and referring physicians, ensuring all referral requirements are met prior to scheduling or treatment. • Track referral status and proactively follow up with provider offices, payers, and patients to ensure referrals are received and remain valid. • Accurately document insurance coverage, benefit information, referrals, and eligibility details within internal systems. • Communicate insurance coverage, patient financial responsibility, estimated out-of-pocket costs, and Oshi's billing model in a clear, professional, and empathetic manner. • Research and resolve eligibility, coverage, referral, and insurance discrepancies that may impact patient care or reimbursement. • Monitor eligibility verification queues, insurance changes, pending requests, and coverage updates to ensure timely resolution. • Identify and resolve claim rejections related to eligibility, benefits, coverage, or referral issues. • Maintain open communication with patients, providers, payers, and internal stakeholders to resolve eligibility, referral, and insurance-related questions. • Collaborate with Billing, Accounts Receivable, Clinical Operations, and other cross-functional teams to improve patient access, billing accuracy, and reimbursement. • Analyze eligibility, referral, and benefit verification data to identify trends, root causes, and opportunities for process improvement. • Monitor and report on eligibility, referral, and verification metrics to support operational performance and continuous improvement. • Contribute to workflow enhancements that improve operational efficiency, reduce claim denials, and enhance the patient financial experience. • Ensure compliance with organizational policies, payer requirements, HIPAA, and healthcare billing and eligibility regulations.

🎯 Requirements

• Bachelor's Degree in Business Administration or relevant course work. • 2+ years of healthcare revenue cycle experience with a focus on eligibility, benefits, insurance verification, or patient access. • Experience verifying insurance eligibility, benefits, authorizations, and obtaining referrals across multiple commercial and government payers. • Hands-on experience using payer portals, Availity, and other insurance verification tools, including phone verification. • Experience working successfully in a remote work environment with the ability to manage priorities independently. • Proficiency with EMR and insurance verification systems. • Strong customer service, communication, and interpersonal skills. • Strong organizational, analytical, and problem-solving skills with exceptional attention to detail. • Proficiency with Google Workspace (Sheets, Docs, Gmail) and the ability to quickly learn new systems and technology.

🏖️ Benefits

• Employer-sponsored medical, dental, and vision coverage • Unlimited PTO + 11 paid company holidays • Eligibility to contribute to 401(k) • Tailored professional development opportunities as we scale • Access to Overalls, because we know life happens