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Eligibility Representative I in Los Angeles, CA at TeamHealth

Date Posted: 7/29/2018

Job Snapshot

Job Description

Join a team of dynamic, results oriented professionals!

Named among “The World’s Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among “Great Places to Work" by Becker’s Hospital Review

  • Career Growth Opportunities
  • Convenience market on site
  • Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
  • 401K program (Discretionary matching funds available)
  • Employee Assistance Program
  • Referral Program
  • Dental plans & Vision plans
  • GENEROUS Personal time off
  • Eight Paid Holidays per year
  • Quarterly incentive plans
  • Business casual dress code
  • Free Parking
  • Free coffee daily
  • Employee of the month awards with monetary gift and parking space
  • Training Programs
  • Fitness Center with personal trainer on site
  • Awesome Facility with terrific amenities
  • Wellness programs
  • Flexible work schedule

JOB DESCRIPTION OVERVIEW:

Under direct supervision, the Registration Eligibility Specialist I is responsible for the resolution of insurance eligibility denials through various methods such as website research, calling insurance companies to verify coverage and benefits or by contacting the facility and/or the patient. The position works in a cooperative team environment to provide value to customers (internal and external). The Registration Eligibility Specialist I carries out his/her duties by adhering to the highest standards of ethical and moral conduct, acts in the best interest of TeamHealth and fully supports TeamHealth focus on supporting its physicians while following the TeamHealth office policies and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Responsible for contacting insurance companies and navigating payer websites to obtain accurate status information of outstanding claims and inputs accurate information into the computer billing system
  • Responsible for having working knowledge of payer eligibility and benefits verification/billing guidelines. Has complete understanding and working knowledge of navigating payer websites.
  • Assisting in identifying and resolving payer trends and issues related to eligibility denials and rejections.
  • Researches insurance eligibility via website or by calling the insurance company, patient, or hospital in order to resolve eligibility denials/rejections in a timely and accurate manner.
  • Maintains thorough and detailed knowledge of various insurance contracts and eligibility denials and follow up guidelines.
  • Enters corrections and reposts to the correct insurance type.
  • Maintains good working knowledge of the contract tables and Case Rate plans.
  • Responsible for submitting corrected claims to appropriate payers in a timely manner if needed.
  • 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 Commercial, Medicare, Medicaid, Managed Care and other payers.
  • 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-9/ICD-10 coding regulations and guidelines.
  • Continually seeks to understand and act upon employer/customer needs, concerns, and priorities. Meets employer/customer expectations and requirements, and gains employer/customer trust and respect.
  • 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.
  • May perform special assignments and other related tasks as assigned.

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Normally, the knowledge, skills and abilities necessary for adequate job performance can be obtained through approximately one+ years’ experience with insurance denial (particularly Eligibility denials) and correspondence processes within a multi-facility environment.
  • In addition, working knowledge of insurance processes, denials, and insurance eligibility requirements
  • Also, demonstrated success working in a team environment focused on meeting organization goals and objectives is necessary.
  • Experience with providing visible participation and support of major change initiatives preferred.
  • Some college coursework in business administration or accounting preferred.
  • Knowledge of basic math and the ability to perform math functions in units of American currency.
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form.
  • Ability to review documents for accuracy and reasonability.
  • Ability to work well under pressure.
  • Tact and patience when dealing with individuals at all levels, both within and outside the company.
  • Commitment to TeamHealth values
  • Ability to communicate effectively orally, in person and on the telephone, and in writing, with individuals at all levels, both within and outside the company.
  • Knowledge of coordination of benefits requirements and processes.
  • Knowledge of health insurance correspondence denial processing.
  • Knowledge of insurance rejection/denial processing to perform follow up activity.
  • Ability to multi-task, set priorities and follow through without direct supervision.
  • Ability to type efficiently and accurately.
  • Ability to operate a computer (i.e., Microsoft Office and internet) efficiently and accurately.
  • Ability to operate various office machines (i.e., fax, copier).
  • Ability to work well in a team environment and be flexible in problem solving environment.

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • Have good attendance.
  • Work at a desk, utilizing a computer.
  • Communicate by telephone.
  • Operate a PC and other office equipment (copier, fax, etc.).
  • Move freely between offices
  • The work environment corresponds to the average office environment.

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.