Eligibility Specialist II - RCO Financial Clearance

EDUCATION & EXPERIENCE:

Minimum Qualifications:

Three years of financial experience or two years patient accounts experience.

JOB SUMMARY:

Performs follow-up activities on outstanding hospital and physician accounts and assists patients in the Medicaid/SSI application process. Takes necessary action to ensure timely and appropriate reimbursement and/or account resolution.

ESSENTIAL JOB FUNCTIONS:

• Assists patients in the Medicaid/SSI application process, converting unfunded patients into funded patients
• Acts as a liaison between the patient and various agencies such the Health and Human Services Commission (HHSC), the Social Security Administration (SSA), etc
• Coordinates and processes various forms/paperwork necessary for Medicaid/SSI reimbursement, UTMB admissions, and/or other related forms
• Maintains open and professional communication with customers, colleagues and vendors
• Updates information and enters appropriate codes in the patient accounting system
• Maintains comprehensive knowledge of the work unit assigned
• Prepares and maintains reports related to job duties
• Updates and develops departmental policies and procedures
• Assists in the training and mentoring of new employees
• Adheres to established policies and procedures
• Adheres to internal controls and reporting structure
• Performs detailed follow-up activities on assigned accounts according to procedures
• Resolves outstanding AR accounts at a defined level of productivity
• Validates accuracy of payments and/or adjustments on accounts
• Processes account adjustments according to policy and procedures
• Researches and resolves credit balance accounts
• Identifies and/or prepares and processes account refunds
• Responds to daily correspondence
• Verifies eligibility for coverage with any commercial insurance, government or charity programs
• Performs account reviews, audits, and/or appeals
• Performs quality assurance reviews

Marginal or Periodic Functions:

• Successfully completes competency based training and testing on an annual basis
• Prioritizes and completes all work in an accurate, effective and efficient manner
• Participates in team meetings/activities and supports the philosophy and goals of the team and department
• Participates in special projects/assignments
• Reads all announcements and relevant communications relating to job duties
• Performs related duties as required.

WORKING ENVIRONMENT/EQUIPMENT:

• Standard hospital, clinical, laboratory and/or office environments.
• Standard office equipment.

SALARY RANGE:

Actual salary commensurate with experience.

WORK SCHEDULE:

On-site, full-time, 40 hours per week.