Remote Eligibility Specialist

Summary

Join our Revenue Cycle team as an Eligibility Specialist to verify patient insurance coverage, ensure eligibility for services, and maintain a smooth billing process.

Requirements

• Minimum of 2 years of experience in medical billing, insurance verification, or eligibility-related roles
• Proficient with AthenaHealth, insurance payer portals and other eligibility verification systems
• Must have eligibility experience with major commercial plans, preferably across multiple states in a telehealth model
• Strong verbal and written communication skills, with the ability to explain complex insurance details to patients and internal team members
• Proven ability to investigate, resolve, and prevent issues related to insurance verification and eligibility
• High degree of accuracy in verifying patient data and maintaining records

Responsibilities

• Accurately verify patient insurance coverage, benefits, and eligibility using systems like AthenaHealth and payer portals
• Obtain and track pre-authorizations for services when required by the payer
• Identify primary and secondary insurance coverage to ensure proper coordination of benefits and avoid future claim denials
• Maintain accurate and up-to-date documentation of insurance verification outcomes in the system, ensuring billing compliance
• Collaborate with billing specialists and patients to resolve eligibility-related issues, claim holds, or denials
• In collaboration with Operations team, maintain proprietary insurance-provider mapping database to ensure billing compliance
• Notify patients of any discrepancies in coverage or issues with their insurance eligibility, providing patients with clear guidance and options
• Ensure patient insurance information is correctly recorded and maintained for accurate billing and reimbursement
• Conduct follow-up on pending insurance verifications to prevent delays in billing or service delivery
• Use AthenaHealth, payer portals and other tools efficiently to confirm patient eligibility and verify coverage before appointments

Benefits

• 100% remote opportunity
• Competitive compensation aligned with experience
• Comprehensive health benefits (medical and dental)
• Paid time off
• Paid holidays