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Mental Health Partners Eligibility Specialist | Revenue Cycle Team in United States

Purpose:

To ensure maximum reimbursement through proper eligibility verification and maintenance of client financial records through extensive knowledge of full revenue cycle.

Job Summary:

The Eligibility Specialist will gain and maintain extensive knowledge of all payment plans, authorization process and eligibility set-up in system. Connect revenue cycle functions between clinical settings and business office.

Essential Functions:

  • Verify all client eligibility via electronic health record, Medicaid portal, insurance company websites, etc., to ensure payment of services rendered.

  • Ensure data entry in client financial record is timely and accurate.

  • Obtain all authorizations for services and ensure on-going authorizations are managed in a timely manner.

  • Identify problems with client eligibility/insurance coverage and correct.

  • Outreach clients to discuss financial supports and concerns ensuring they are given the tools to create financial wellness.

  • Provide supports to front desk staff through solid relationships and communications.

  • Reconcile eligibility/insurance coverage discrepancies and track documentation of conversations in the electronic health record.

  • Assist with creating and generating reports as needed.

  • Utilize team to discuss, enhance and resolve issues.

  • Participate in team meetings.

  • Regular and consistent attendance is required to perform other essential functions of the job

  • Meet defined department goals and activity Metrics and Key Performance Indicators.

  • Promote and demonstrate MHP’s mission, vision and values through both behavior and job performance on a day to day basis

  • Effectively interact and communicates with other MHP staff/clients/customers/partners/etc

  • Other duties as assigned

Knowledge/Skills/Abilities:

  • Bilingual/Bicultural (Spanish)

  • Must be able to work independently

  • Must be dependable and punctual

  • Demonstrated organizational and time management skills

  • Must demonstrate excellent customer facing skills; maintain a professional image and handle stressful situations in a calm manner

  • Must be able to multitask

  • Must demonstrate critical thinking skills

  • Ability to follow direction and contribute in a positive, proactive way

  • Must be a team player, adaptable, and flexible

  • Ability to communicate effectively, both verbal and written

  • Ability to research and solve problems

  • Excellent attention to detail and accuracy

  • Intermediate computer skills including knowledge of MS Excel, MS Word, MS Outlook and ability to use electronic health record

Education/Experience/License/Certification

  • High School Diploma or GED required or Bachelor’s degree

  • Three (3) years recent experience in health care front office, registration and/or customer service settings

  • Strong working knowledge of health care benefits including Medicaid, Medicare, CHP+, managed care and/or traditional insurance

  • Strong working knowledge of medical billing processes, self-pay collections, third party payer billing regulations and reimbursement requirements

  • Successful negotiating techniques

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