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Eligibility Specialist
Pinnacle Home Care. Verify patient insurance eligibility and benefits for new, returning, and existing patients within established departmental timeframes.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in verifying patient insurance eligibility and benefits, with a strong focus on accurate documentation and effective communication with patients and internal departments. Proficient in navigating healthcare information systems and maintaining compliance with HIPAA regulations.
Highest-signal resume keywords
Insurance VerificationHealthcare ExperienceWellSky ProficiencyMedicare and Medicaid KnowledgeHIPAA Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Insurance Eligibility VerificationMedical BillingDocumentation AccuracyPayer Information ProcessingCoverage Limitations Knowledge
Soft Skills
Effective CommunicationProblem ResolutionCollaborationAttention to DetailTime Management
Tools & Technologies
Electronic Medical RecordsPayer PortalsWellSky
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
HealthcareHome HealthManaged CareCommercial InsurancePatient Services
About the role
Key responsibilities & impact- Verify patient insurance eligibility and benefits for new, returning, and existing patients within established departmental timeframes.
- Review and resolve insurance eligibility issues identified in WellSky and other applicable systems.
- Process and update insurance changes, payer information, and related demographic or coverage information.
- Accurately document eligibility and benefit information in patient records.
- Communicate eligibility changes, discrepancies, and coverage concerns to branches and internal departments.
- Identify and escalate eligibility, coverage, or payer-related issues affecting patient services, authorizations, billing, or reimbursement.
- Collaborate with the Eligibility Team Lead and Authorization Manager on complex eligibility matters and unresolved discrepancies.
- Communicate with patients, insurance companies, payer representatives, branch personnel, and internal departments to obtain and clarify insurance information.
- Respond to eligibility-related inquiries and resolve concerns, discrepancies, and account issues.
- Maintain accurate documentation of eligibility verification activities and communications.
- Monitor assigned accounts and follow up on outstanding eligibility issues.
- Meet productivity, accuracy, quality, and turnaround-time expectations.
- Participate in training, staff meetings, quality initiatives, and process-improvement activities.
- Perform other related duties as assigned.
Requirements
What you’ll need- High school diploma or GED required.
- Minimum of one (1) year of healthcare, medical billing, insurance verification, eligibility, or related experience required.
- Experience verifying insurance eligibility and benefits preferred.
- Experience in home health or another healthcare setting preferred.
- Experience working with electronic medical records and payer portals preferred.
- Previous experience with Medicare, Medicaid, managed care, commercial insurance, or other healthcare payer systems preferred.
- Previous home health experience preferred.
- Experience with WellSky or similar healthcare information systems preferred.
- Knowledge of insurance eligibility, benefits, deductibles, copayments, coinsurance, and coverage limitations preferred.
- Maintain confidentiality and comply with HIPAA and all applicable privacy and security requirements.
- Follow Pinnacle Home Care policies, procedures, standards of conduct, attendance requirements, and applicable regulatory requirements.
Benefits
Comp & perks- Personalized, One-on-One Care: Help patients heal and regain their independence by delivering individualized care in the comfort of their homes.
- Free Continuing Education Units (CEUs) to support licensure and career advancement.
- Employee referral program where you can earn rewards.
- Flexible Scheduling.
- Supportive and collaborative team culture.
- Equal opportunity and inclusive workplace.