<p>Our client is seeking a highly motivated and detail-oriented <strong>Eligibility Specialist</strong> for a remote, contract-to-hire position. The Eligibility Specialist will play a crucial role in ensuring the financial clearance of patient accounts, focusing on eligibility verification, resolving claim discrepancies, and guaranteeing the timely submission of clean claims to insurance companies. This is a fast-paced role that demands precision, analytical skills, and exceptional communication abilities.</p><p><br></p><p><strong>Key Responsibilities</strong></p><p><strong>1. Eligibility Verification</strong></p><ul><li>Conduct detailed reviews of patient insurance coverage and benefits for laboratory services.</li><li>Collaborate with teammates, clinics, patients, and insurance companies to verify coverage details and address any discrepancies.</li><li>Maintain accurate and comprehensive documentation of eligibility information in the revenue cycle management (RCM) system.</li></ul><p><strong>2. Claim Error Processing</strong></p><ul><li>Analyze and promptly resolve claim errors identified in the RCM system, including billing and coding discrepancies.</li><li>Work closely with team members to ensure compliance with policies, procedures, and medical necessity requirements.</li><li>Address and reconcile discrepancies to prepare clean claims for timely submission.</li></ul><p><strong>3. Additional Duties</strong></p><ul><li>Assist in other related tasks as assigned by leadership.</li></ul>

<p><strong>Qualifications</strong></p><ul><li><strong>Education</strong>: College degree is preferred, but equivalent experience (5+ years) in a similar role will be considered.</li><li><strong>Experience</strong>: A minimum of <strong>5 years</strong> in medical billing or financial clearance roles is required.</li><li>Strong understanding of patient protections under HIPAA, including proper handling of protected health information (PHI).</li><li>Extensive knowledge of insurance plans, billing procedures, claim terminology, CPT/ICD-10 codes, and medical technology.</li><li>Experience with laboratory billing software (e.g., Telcor, Xifin, or Quadax) is a bonus.</li></ul><p><strong>Skills</strong></p><ul><li>Exceptional attention to detail and strong problem-solving abilities.</li><li>Effective communication and interpersonal skills, with the ability to collaborate with diverse teams.</li><li>Expertise in Microsoft Office Suite and familiarity with healthcare software tools.</li><li>Ability to manage time efficiently in a high-volume, fast-paced work environment.</li></ul><p><br></p>

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