Eligibility Specialist

Summary

Join Grow Therapy as an Eligibility Specialist and contribute to improving mental healthcare access. You will be responsible for verifying patient eligibility and benefits, investigating and resolving denials, and ensuring accurate claims submission. This role involves utilizing clearinghouses, payer portals, and contacting insurance carriers. You will also work with Customer Support to answer eligibility questions and maintain accurate patient data. The ideal candidate is process-driven, adaptable, and has at least two years of experience in medical billing or a healthcare setting. Grow Therapy offers a competitive salary and comprehensive benefits.

Requirements

• Process-Driven: Highly organized, operational thinker, rarely leaving questions unanswered
• Adaptable: You are comfortable in a fast-paced environment, with priorities changing weekly
• Healthcare Experienced: Strong understanding of healthcare claims, plan benefits, and patient responsibilities. At least 2 years of experience in Medical Billing or Healthcare setting
• Team Player: You are collaborative by nature, relish in camaraderie and group wins, and are looked to by colleagues or direct reports as a steadfast partner & source of encouragement

Responsibilities

• Utilize clearinghouses like Availity and Claim MD, along with payer portals, to verify patient eligibility and benefits, ensuring accurate claims submission
• Investigate and resolve eligibility-related denials by researching coverage details and correcting discrepancies
• Complete outbound calls to insurance carrier representatives and supervisors to investigate denial reasons
• Resubmit claims with errors, utilizing knowledge of CMS 1500 forms and a broad understanding of data, coding, and policy errors
• Draft appeals for relevant claim denials, adhering to medical policies for all insurance carriers
• Ensure patient data in software is correct and most up to date, contacting the appropriate person for any inconsistencies
• Prioritize workflows based on age of claims

Benefits

• Comprehensive health insurance plans, including dental and vision
• Flexible working hours
• Flexible Time Off
• Company-wide winter break
• Mental health mornings (2 hours each week)
• Wellness Stipend
• In-office meals and snacks
• Continuous learning opportunities
• Competitive salary
• The opportunity to help build a rapidly scaling start-up organization by taking strong ownership of your work, mentorship, and our unbounded leadership opportunities