Eligibility Specialist

🔥 0 minutes ago

🌽 Illinois, Iowa, +3 more states – Remote

🌽 Illinois – Remote 🌾 Iowa – Remote 🌾 Nebraska – Remote 🌲 North Carolina – Remote 🚗 Michigan – Remote

💵 $20 - $23 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Lighthouse Autism Center

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Private Equity Round on 2021-07

Healthcare • Healthcare Insurance

Lighthouse Autism Center is a dedicated facility providing comprehensive therapy services for children with autism. With over a decade of experience, they offer a wide range of personalized, evidence-based therapeutic approaches such as ABA therapy, speech therapy, and school readiness programs. Their compassionate and clinically excellent team aims to unlock each child's unique strengths and potential in a nurturing environment, supporting families in the Midwest. Through innovative models like the Lighthouse Fusion approach, they make a significant difference in the developmental paths of children on the autism spectrum.

📋 Description

• Complete insurance eligibility and benefit verification for new and existing learners • Review and validate eligibility results, member status, effective dates, plan information, benefits, limitations, exclusions, and payer requirements • Identify primary and secondary coverage and coordination-of-benefits considerations • Verify provider and service-location network status and identify insurance-related barriers • Identify requirements before services begin, including assessment or treatment authorization needs • Partner with Intake, Clinical Operations, and Authorization teams to address requirements, missing information, and barriers • Initiate and coordinate assessment authorization requests • Monitor authorization requests through determination and complete payer follow-up • Document and communicate approved authorizations • Obtain, document, and maintain insurance and authorization records in CentralReach and other designated systems • Complete eligibility and benefit rechecks when coverage changes or validation is needed • Route insurance changes and authorization-impacting issues to the appropriate team • Review automated eligibility and insurance transactions and resolve exceptions requiring manual intervention • Identify recurring eligibility, payer, and automation issues and communicate trends and process-improvement opportunities to the Supervisor • Use Solum Health, CentralReach, and other designated systems according to workflows and payer requirements • Participate in testing, training, process improvement, and optimization of eligibility and intake insurance workflows

🎯 Requirements

• High school diploma or equivalent required • Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred • Minimum of one (1) year of experience in insurance, eligibility verification, medical billing, prior authorization, or a related field preferred • Strong understanding of health insurance eligibility, benefits, coverage limitations, exclusions, deductibles, and out-of-pocket requirements • Ability to accurately interpret insurance benefits and identify requirements affecting access to behavioral health services • Strong understanding of eligibility verification, benefit coverage, and assessment authorization requirements • Strong attention to detail and accuracy • Ability to recognize discrepancies, coverage issues, and potential barriers and escalate them appropriately • Excellent organizational and time-management skills • Strong written and verbal communication skills • Ability to navigate payer portals, electronic eligibility systems, CentralReach, Solum Health, and other technology platforms • Ability to work independently, exercise sound judgment, follow established workflows, and recognize when escalation is required • Ability to collaborate with Intake, Clinical Operations, Credentialing, and Authorization teams • Ability to sit for prolonged periods; occasionally stand, walk, use a keyboard, and lift or move up to 25 pounds • Vision requirements include close vision, distance vision, depth perception, and ability to adjust focus

🏖️ Benefits

• Fully remote work arrangement