Eligibility and Benefits Specialist

This is a remote position.

• Monday to Friday
  
• 8am to 4:30pm Tucson, AZ Time with a 30-minute unpaid break 
  
  

We are seeking an experienced Eligibility and Benefits Specialist to join our team. The ideal candidate will have a strong background in reviewing and interpreting healthcare insurance policies and will excel in communicating benefits information to clients. This role is critical in ensuring that our billing software aligns with the most up-to-date insurance policies, thereby enhancing our service delivery and client satisfaction.

Key Responsibilities:

• Review and interpret healthcare insurance policies to ensure accurate understanding of client benefits.
  
• Communicate clearly and effectively with clients regarding their eligibility and benefits, addressing any questions or concerns they may have.
  
• Update and maintain billing software to reflect the latest insurance policy information, ensuring accuracy in client accounts.
  
• Collaborate with internal teams to identify and resolve issues proactively before they impact clients.
  
• Utilize problem-solving and critical thinking skills to assess complex situations and provide effective solutions.
  
• Stay informed about changes in healthcare regulations and insurance policies to ensure compliance and accurate communication with clients.
  
• Assist in training and supporting team members on eligibility and benefits processes and policies.
  
• Document client interactions and maintain accurate records related to eligibility determinations and benefit explanations.
  

Qualifications:

• Bachelor’s degree in healthcare administration, business, or a related field (preferred).
  
• Minimum of 2 years of experience in reviewing and interpreting healthcare insurance policies.
  
• Strong understanding of healthcare benefits, eligibility criteria, and billing processes.
  
• Excellent communication skills, both written and verbal, with the ability to convey complex information in an understandable manner.
  
• Demonstrated problem-solving and critical thinking skills to address client issues effectively.
  
• Proficiency in billing software and relevant healthcare technology systems.
  
• Detail-oriented with strong organizational skills and the ability to manage multiple priorities.
  
• Ability to work independently and collaboratively within a team environment.