Eligibility and Risk Specialist

JOB RESPONSIBILITIES: Responsible for verifying eligibility and risk delegation for health plan members and properly maintaining the customer records Ensure that all eligibility verification requests are completed in a timely manner Research problems and find solutions to eligibility related claim rejections and denials Inform management of changes or trends with eligibility and risk issues Research denials and billing requirements of third-party carriers utilizing web portals, phone contact, EOBs, provider manuals, etc. Adjudicate claims issues by preparing and submitting corrected claims or appeals Recommend claims for write-off when billing requirements are not met Effectively communicate by phone, email, and in-person with third-party payers and internal staff to resolve eligibility issues and establish positive relationships Accurately update and notate accounts receivable system, collections notepad, and customer accounts Remain updated on company policies and procedures and third-party payer guidelines, bulletins, and billing requirements Work reports and projects assigned by management Ensure appropriate follow-up and timely completion of assignmentsQUALIFICATIONS:Familiarity with various medical insurance payer guidelines/billing requirements preferred Proficiency in Microsoft Office with experience working in Microsoft ExcelMust be detail oriented, thorough, accurate, and organized Proven ability to research and solve problems Good written and verbal communication skills