Eligibility and Error Processing Specialist I

Description

ABOUT PRECISION DIAGNOSTICS:

Precision Diagnostics, based in San Diego, California is a fast-growing clinical laboratory that specializes in providing quantitative drug testing, primarily for the purpose of helping physicians monitor their patient's undergoing treatment for pain or substance abuse. Precisions objective is to improve patient adherence/compliance with their prescription regimen and protect medical practices from liability.

The Eligibility and Error Processing Specialist I is responsible for the verification and resubmission of each accession that is entered into Billing system from our LIS system via the Web services interface that resulted in a front-end edit due to payor provisions in accordance with current policy and procedure and to bring account to final resolution.

THE ROLE:

• Run reports for all accessions that cannot be billed to the third-party payor for lack of demographic and financial related information.

• Use and manage multiple computer systems, applications, and websites to make accurate determinations to submit accessions to the responsible entity

• Identify and verify all Insurances (Medicare, Medicaid, Commercial, Workers Compensation) associated with accessions based on guidelines set by Supervisor.

• Resolve and resubmit accessions with various front-end edits and eligibility errors set forth by the Payor.

• Review and interpret documents such as Eligibility Benefit Information and Explanation of Benefits

• Ensure all data has been verified and updated with accuracy as needed to meet productivity and quality requirements

• Communicates Payor and Client updates to Supervisor based on eligibility or source documents that are reviewed.

• Analysis and review of billing front end errors data to identify root causes and work with Supervisor to implement upfront system edits as applicable.

• Establish and maintain a working knowledge of Insurance Provider Portals and their Eligibility policies.

• Contact Clients and or Insurance Companies for more complex eligibility issues via Telephone and or Fax.

• Maintain high level of confidentiality and privacy in accordance with organizational policies.

• All other duties as required.

WHAT YOU BRING TO THE TABLE:

• Excellent verbal, written and interpersonal communication skills

• Excellent organization skills and attention to detail

• Demonstrates an independent work initiative, sound judgment and strong work ethic

• Works cooperatively in a team atmosphere

• Ability to handle multiple tasks simultaneously

• High school or GED

• Preferred 1-3 year experience in a Data entry and verification in a lab, medical hospital or outpatient practice setting required

• To be successful, you agree that technology is a key part of every business process, and you will make new technology adoption part of your routine

• Become fluent in Microsoft 365 (formerly Office635) applications assigned to your role. Common applications include: Teams, Word, Excel, Tasks and Planner

• Complete training in a timely manner that is assigned to you. Training is primarily conducted via Microsoft Learn modules and is assigned based on:

• Position/Job Role Most positions require a core set of Microsoft 365 working knowledge

• Project Role As member of a project team, you may be required to complete training before you can engage with the project team or commence project work

• Ad-Hoc Based on review of your performance via support requests, training modules will be assigned to increase skills

ADDITIONAL JOB CONSIDERATIONS:

• This position is Full-Time

• Pay range is $21.00-$28.00 per hour

• Flexible start times between 5:00am and 8:30am

• Must be able to sit at a desk for prolonged periods and working on a computer

• Comprehensive benefits package: Medical, Dental, Vision, and additional optional coverages

• 401K with company match

• Paid time off and paid Holidays

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications