Eligibility Specialist

At The CORE Institute, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:

• Competitive Health & Welfare Benefits


• Monthly $43 stipend to use toward ancillary benefits


• HSA with qualifying HDHP plans with company match


• 401k plan after 6 months of service with company match (Part-time employees included)


• Employee Assistance Program that is available 24/7 to provide support


• Employee Appreciation Days


• Employee Wellness Events

QUALIFICATIONS

• High school diploma/GED or equivalent working knowledge preferred.


• Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role that includes heavy insurance benefits verification experience.


• Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers, and other funding sources.


• Knowledge of government provisions and payers, and Coordination of Benefits.


• Working knowledge of Centricity Practice Management and Centricity EMR a plus.


• Coding and billing knowledge/experience is a plus.


• Knowledge of commercial plans, Medicare, Medicaid, and physical therapy benefits is a plus.

ESSENTIAL FUNCTIONS

• Obtains benefit verification and necessary authorizations (referrals, precertification, authorizations) prior to patient arrival for all Physical Therapy services.


• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility. Calls insurance companies to discuss physical therapy benefits and authorizations that are not available through online resources.


• Completes Explanation of Insurance Benefits form for patients, new patient paperwork, and serves as a member of the front office team to prep Front Office Reps for the patient’s arrival. Maintains proper Appointment Status settings for each visit, as well as ensures proper authorizations are secured prior to the patient visit.


• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.


• Reviews insurance denials and rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding denials/rejections.

The Physical Therapy Eligibility Specialist is responsible for completing the pre-registration, registration, eligibility, verification of benefits, pre-certification documentation, and insurance authorization processes

The CORE Institute team is dedicated to making the lives of others better by practicing exceptional patient care. If you would like to be part of a dedicated, dynamic healthcare team in a challenging, rewarding environment, The CORE Institute is the right place for you to grow your career.