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 services being rendered.

• Acquire referrals from primary care providers and specialist physicians.

• Monitor the status of referrals and proactively follow up with provider offices, payers, and patients.

• Record insurance coverage, benefit information, referrals, and eligibility details in internal systems.

• Convey coverage details, patient financial responsibilities, estimated out-of-pocket expenses, and billing models.

• Investigate and address eligibility, coverage, referral, and insurance inconsistencies.

• Oversee verification queues, track insurance changes, pending requests, and updates to coverage.

• Resolve claim denials related to eligibility, benefits, coverage, or referrals.

• Interact with patients, providers, payers, and internal stakeholders effectively.

• Collaborate with Billing, Accounts Receivable, Clinical Operations, and cross-functional teams.

• Analyze verification data to uncover trends, root causes, and potential process enhancements.

• Track and report on eligibility, referral, and verification metrics.

• Enhance workflows, operational efficiency, claim denial rates, and the overall patient financial experience.

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

⛳️ Requirements

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

• Over 2 years of experience in healthcare revenue cycle management, specifically in eligibility, benefits, insurance verification, or patient access.

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

• Practical experience utilizing payer portals, Availity, and other insurance verification instruments, including phone verification.

• Demonstrated success in a remote work setting, effectively managing priorities independently.

• Proficient in EMR and insurance verification systems.

• Excellent customer service, communication, and interpersonal capabilities.

• Strong organizational, analytical, and problem-solving skills with a keen eye for detail.

• Familiarity with Google Workspace (Sheets, Docs, Gmail) and a quick aptitude for learning new systems and technologies.

🏝️ Benefits

• Bonus eligibility.

• Employer-sponsored medical, dental, and vision coverage.

• Flexible time off.

• 11 paid company holidays.

• Eligibility to contribute to a 401(k) plan.

• Remote-first work environment—ability to work from home within approved states.

• Customized professional development opportunities.

• Access to Overalls life concierge service.