Eligibility Specialist

This position will help directly improve our Pre-Service operations and expand access to care. You will be responsible for all aspects of our eligibility processes to ensure client coverage is verified prior to care. You will report directly to a Team Lead on our Eligibility team to streamline eligibility workflows, identify opportunities for improved processes, and ensure care is covered prior to service. You will utilize clearinghouses like Availity and Claim MD, along with payer portals, to verify patient eligibility and benefits, ensuring accurate claims submission. You will investigate and resolve eligibility-related denials by researching coverage details and correcting discrepancies. The candidate will complete outbound calls to insurance carrier representatives and supervisors to investigate denial reasons. Furthermore, you will resubmit claims with errors, utilizing knowledge of CMS 1500 forms and a broad understanding of data, coding, and policy errors.