Eligibility Verification & Benefit Specialist

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description:

Role Summary:

Eligibility Verification and Benefit Specialist are responsible for verifying all new patients entering the Practice Management system including hospital patients. Identify any possible benefits issues or trends based on responses from the electronic verification system.

Responsibilities:

• Work and complete new patient task and performs initial verification on all new patients for assigned locations prior to appointment.
• Check daily the electronic verification system to identify any possible benefit issues for patients with same day or future appointments and communicates any concerns to the appropriate staff.
• Properly flags accounts on possible benefit issues by documenting accounts and notifying appropriate parties as necessary.
• Requests initial referral for appropriate patient appointments, enters documentation into Patient Management system, and notifies the Sr. Eligibility Verification and Benefit Specialist.
• Maintains working knowledge of Coordination of Benefits as it relates to identifying possible claim issues prior to patient visit.
• Stays current on insurance changes utilizing all resources available (web sites, bulletins, emails, etc).
• Communicate any insurance changes to appropriate staff.
• Communicate when a patient becomes Self Pay, or obtains insurance after being Self Pay to the appropriate staff.
• Documents coverage comments in Electronic Medical Record (EMR) system when reimbursement should be evaluated.
• Communicates with the team supervisors regarding issues with payer responses or trends in the electronic eligibility system.
• Follows policies and procedures as outlined by management to ensure standardization of processes.
• Notifies Eligibility Verification and Benefit Team Management of any issues that have potential for a negative outcome for the company

Required Qualifications:

EDUCATION & EXPERIENCE:

• High School diploma or equivalent.
• One year experience in a directly related role preferred, but not required.

Essential Competencies:

• Attendance is an essential job function.
• Ability to work effectively with all levels of management and other colleagues
• Ability to demonstrate initiative and mature judgment.
• Ability to demonstrate high degree of professionalism and adaptability.
• Ability to demonstrate proficiency in the use of end-user computer applications (MS work, Excel, Outlook), database and patient scheduling and other medical information systems.
• Ability to demonstrate strong customer service delivery skills.
• Ability to utilize websites, portal and electronic options when available to increase efficiency
• Ability to follow oral and written instructions.
• Ability to recognize and solve problems using creative thinking skills, hands on problem solving skills and the ability to analyze and respond to data.
• Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
• Skilled at Multi-tasking, organizational skills and superb attention to detail.
• Working knowledge of Hospice and other payer requirements.
• Knowledge of clinic office procedures, medical practice and medical terminology.

The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.

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