Eligibility and Benefits Specialist

This is a fully remote position, open to applicants in Arizona, +11 more states.

📋 Description

• Confirm patient insurance eligibility, benefits, authorization prerequisites, and referral requirements prior to delivering services.

• Acquire referrals from primary care providers and referring physicians, ensuring all necessary referral conditions are satisfied before scheduling or treatment.

• Monitor referral status and proactively engage with provider offices, payers, and patients to confirm referrals are received and remain valid.

• Precisely document insurance coverage, benefit details, referrals, and eligibility information within internal systems.

• Clearly communicate insurance coverage, patient financial obligations, estimated out-of-pocket expenses, and Oshi's billing model in a professional and empathetic manner.

• Investigate and resolve discrepancies related to eligibility, coverage, referrals, and insurance that may affect patient care or reimbursement.

• Oversee eligibility verification queues, insurance modifications, pending requests, and coverage updates to ensure prompt resolution.

• Identify and rectify claim rejections associated with eligibility, benefits, coverage, or referral concerns.

• Maintain ongoing communication with patients, providers, payers, and internal stakeholders to address eligibility, referral, and insurance-related inquiries.

• Work collaboratively with Billing, Accounts Receivable, Clinical Operations, and other cross-functional teams to enhance patient access, billing precision, and reimbursement.

• Analyze data related to eligibility, referrals, and benefit verification to detect trends, root causes, and opportunities for process enhancement.

• Monitor and report on eligibility, referral, and verification metrics to support operational performance and ongoing improvement.

• Contribute to workflow improvements that enhance operational efficiency, minimize claim denials, and elevate the patient financial experience.

• Ensure adherence to organizational policies, payer standards, HIPAA, and healthcare billing and eligibility regulations.

⛳️ Requirements

• Bachelor’s Degree in Business Administration or a related field.

• A minimum of 2 years of experience in healthcare revenue cycle focusing on eligibility, benefits, insurance verification, or patient access.

• Proficient in verifying insurance eligibility, benefits, authorizations, and obtaining referrals across various commercial and government payers.

• Practical experience using payer portals, Availity, and other insurance verification tools, including phone verification.

• Proven ability to thrive in a remote work setting while effectively managing priorities independently.

• Skilled in EMR and insurance verification systems.

• Excellent customer service, communication, and interpersonal abilities.

• Strong organizational, analytical, and problem-solving skills with exceptional attention to detail.

• Competent in Google Workspace (Sheets, Docs, Gmail) and quick to adapt to new systems and technologies.

🏝️ 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 grow

• Access to Overalls, because we understand that life happens