Mental Health Partners Eligibility Specialist | Revenue Cycle Team in United States
To ensure maximum reimbursement through proper eligibility verification and maintenance of client financial records through extensive knowledge of full revenue cycle.
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.
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
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
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