Location: Albany NY
Pay $19/hr
Job Summary:
Our client is seeking a detail-oriented and reliable Eligibility Specialist to review monthly accounts for eligibility, verify member and provider details, and ensure accurate processing of referrals, authorizations, and claims.
Key Responsibilities:
✔ Verify & Update Member Eligibility – Use health plan websites and phone verification to ensure accuracy in referrals, claims, and capitation payments.
✔ Provider Eligibility Review – Confirm provider eligibility under Texas Medicaid and contact clinics or patients for alternatives when necessary.
✔ Claims & Billing Support – Research shipments and authorizations, update claims with correct information, and forward determinations to the billing department.
✔ Process Various Tasks – Handle insurance changes, deceased patient files, nursing home cases, and special projects.
✔ Operational & Administrative Duties – Participate in performance improvement initiatives and collaborate across departments.
Qualifications & Requirements:
? Education: High school diploma (or GED) with at least three months of related experience OR an equivalent combination of education and experience.
? Technical Skills: Proficiency in Word, Excel, Adobe, and payor web portals. Experience with Brightree or similar DME billing software is preferred.
? Mathematical & Analytical Skills: Ability to apply basic algebra and percentages to billing calculations.
? Communication & Reasoning Ability: Strong problem-solving, data analysis, and professional communication skills.
? Physical Requirements: Ability to work in an office setting, lift up to 10 lbs regularly and 50 lbs occasionally, and walk up to 1,000 feet when necessary.
Why Join Us?
✅ Collaborative work environment
✅ Opportunities for professional growth
✅ Impactful role in healthcare operations
