Eligibility Specialist

The Manual Eligibility Specialist is responsible for manual updates to the claims system identified as the result of either electronic discrepancy reports or other manual input required. This team member updates eligibility which directly impacts an insured's ability to access care. This position is looking for someone to work in the Canfield Ohio office. Upon completion of training and satisfactory meeting quality and production goals. You will be eligible to participate in our corporate hybrid policy that allows you to work part of the week at home and part of the week in the office.

• Work discrepancy reports identifying manual eligibility research, review and update.
• Research and respond to eligibility questions received from internal and external customers.
• Make any required manual updates to the source system required to trigger enrollment or termination of coverage.
• Coordinate with COBRA and Third Party eligibility vendors on behalf of our clients and customers.
• Follow all HIPAA guidelines for the release of information
• Coordinate escalations with medical review and follow-up timely to assure timeframes and client expectations are met
• Interpret Summary Plan Document language
• Other duties as assigned

• High School/GED required
• Demonstrate skills in problem solving and benefit plan interpretation
• Knowledge of CPT codes, ICD9/ICD10 codes and/or medical terminology is a plus
• Ability to work independently
• PC proficiency
• Average typing ability
• Strong Microsoft skills
• Prefer 1 year experience in healthcare