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Eligibility Representative in Los Angeles, CA at TeamHealth

Date Posted: 9/19/2021

Job Snapshot

  • Employee Type:
    Full-Time
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    9/19/2021

Job Description

JOB DESCRIPTION OVERVIEW:

Under direct supervision, the Eligibility rep is responsible for adding and/or updating Insurance Information provided by GE in a GERD or via a Report. Must be able to work from various source documents. Must be able to properly code patient files according to established policies and procedures. Must be able to identify FSC according to insurance cards and/or patient’s demographics. Eligibility Rep carries out his/her duties by adhering to the highest standards of ethical and moral conduct and acts in the best interest of TeamHealth.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Enters and/or updates Insurance Information. 
  • Identifies appropriate FSC and insurance company.
  • Files or refiles insurance according to GERD response or Report.
  • Uses web sites for carrier research.
  • Makes calls to get correct Insurance information not given by GE or Report.
  • Enters financial comments as to action taken on account.
  • Separates accounts that need further action taken and give to appropriate department.
  • Notifies supervisor and/or senior of system malfunctions.
  • Notifies supervisor and/or senior of problems arising from erroneous items, codes, or missing information.
  • Responsible for all daily productivity reporting requirements.
  • Maintains and exceeds department standards for productivity and quality.
  • Ensures compliance with state and federal laws and regulations for private health information.
  • Performs any and all duties as directed by management.
  • Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
  • Demonstrates ongoing enthusiasm and commitment to the work assigned.
  • Works with others to receive feedback on performance and create a personal developmental plan.
  • Participates in a process to continually improve organizational effectiveness using self-assessment performance evaluation criteria.
  • Responsible for maintaining your workload within your department metric goals
  • Maintains ongoing knowledge of HCFA 1500 and other mandatory state billing forms and filling and follow up requirements and ensures compliance of CPT, HCPCS and ICD-10 coding regulations and guidelines.
  • Coordinates with and provides feedback to management regarding process improvements, trends, errors or issues as they relate to the registration department.
  • May perform special assignments and other related tasks as assigned.

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • College education or 3-5 years of equivalent experience in a medical billing setting, with an emphasis on eligibility verification preferred.
  • BS or BA preferred or equivalent of management/supervisory experience in physician billing related field.
  • Knowledge of health insurance eligibility verification requirements and processes.
  • Knowledge of health care industry and various payers’ guidelines and policies (Medicare, Medicaid, Commercial, HMO, PPO, IPA, TPA, etc.) Knowledge of health insurance terminology.
  • Knowledge of health insurance benefits verification (medical, behavioral, etc.)
  • Knowledge of health insurance requirements and follow up procedures.
  • Knowledge of health insurance patient billing requirements.
  • Familiarity with the revenue cycle process.
  • Understanding of physician billing guidelines for commercial and government payers in multiple states.
  • Excellent written and verbal communication and interpersonal skills.
  • Proven analytical skills and ability to work in a structured, fast-paces environment.
  • Proficiency in working with systems, GE experience is desirable.
  • Must be organized, detail oriented, and meticulous with all tasks.
  • Astute problem solving skills and ability to interrelate and convey information professionally.
  • Medical billing experience with knowledge of the GE system, Microsoft Excel, Microsoft Outlook, and Microsoft Word.
  • Dependable, always conforms to standards for attendance.

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • Set in a pleasant, high-volume, fast-paced office environment.
  • Ability to meet closing deadlines, and production standards is required.
  • Also, may require physical and/or mental stamina to work additional hours beyond a regular schedule and/or more than five days per week.
  • Significant workload that may require after hours work and/or additional hours be mandated by Management.
  • Regular and reliable attendance is necessary.
  • Prolonged work on a PC/computer.
  • Physical requirements include but are not limited to sitting for extended periods of time, walking, and bending.
  • Periodic travel may be required for meetings and trainings.
  • This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.