Revenue Cycle Eligibility Specialist

Description

Easterseals Blake Foundation is celebrating 75 years of continued service in Arizona. We have expanded our services to better serve our community members. We are now one of Arizona's top providers of comprehensive behavioral health services, child welfare, and services for individuals with intellectual and developmental disabilities. We serve more than 40,000 individuals and families across 10 counties in Arizona. Are you ready to make profound, positive differences in people's lives every day?

We offer our full-time employees the following benefits:

• Medical, Dental, and Vision
• 403b and a 50% employer match up to 3%
• Flexible Spending Account and Dependent Flexible Spending Account 
• Health Savings Account
• Voluntary Life insurance
• Voluntary Short-term Disability insurance
• Critical Illness insurance
• Accident insurance
• Employer paid life insurance, long-term disability insurance, and Employee Assistance Program

General Position Description: Perform eligibility tasks for our behavioral health organization.

Essential Duties and Responsibilities:

1. Verifies member insurance coverage and eligibility prior to scheduled appointments 
2. Confirms member benefits, including but not limited to; co-pays, co-insurance and out-of-pocket amounts. 
3. Provides insurance related information to members and/or staff regarding benefits for commercial insurance, state Medicaid (AHCCCS), Medicare, etc.
4. Communicates financial responsibility to members and arranges for payments as needed.
5. Accurately inputs and maintains member insurance data into Electronic Health Record (EHR: Netsmart myAvatar NX).
6. Obtains prior authorizations related to services for members prior to scheduled appointments.
7. Identifies and resolves all insurance related discrepancies pertaining to members via exception reports on a daily, weekly, monthly basis.
8. Monitors member insurance renewal/expiration and works with staff and/or members to avoid lapses in coverage for members. 
9. Works closely with back-end Revenue Cycle staff to minimize eligibility and/or authorization denials.
10. Participates in the process of ongoing professional development and meetings. Maintains comprehensive communication among all contacts within the agency, members, and external agencies. Models professional standards and ethics in accordance with EBF Code of Conduct, Strategic Plan, Mission, and Vision. 
11. Performs other duties as assigned.

Requirements

Minimum Requirements: High School Diploma /GED and 5 years of experience with insurance eligibility and/or authorization process. Bilingual (Spanish) preferred. 

Regulatory 

1. Must be at least 21 years of age. 
2. Current, unrestricted AZ driver’s license with no more than two (2) minor moving violations or one (1) accident within the past three (3 years). Three (3) years of driving experience required.
3. Transportation to attend trainings and perform other work-related activities. Organizational vehicles may not be available at all times. 
4. Must be able to pass a criminal background check prior to employment and regular checks for the duration of the employment.
5. Ability to obtain and maintain an AZ DPS Level 1 fingerprint clearance card (employer provides).

Skills/Job Knowledge/Abilities: Must possess strong knowledge of insurance eligibility, benefit verification, prior authorization processes, and payer requirements, including State Medicaid (AHCCCS), managed care plans, commercial insurance carriers, and Medicare programs and guidelines. Must demonstrate excellent customer service, attention to detail, problem-solving skills, computer proficiency. Must be self-directed, maintain professional standards and ethics in appearance, communication, and actions, and be sensitive to cultural and linguistic diversity while supporting the organization’s mission, vision, strategic plan, and code of conduct.

Working Conditions/Physical Requirements (with or without accommodation): Normal office environment with multiple interruptions in person and through computer and phone. Daily travel to other locations to facilitate training. May lift normal office equipment and materials up to 25lbs. Visual acuity to read information from computer screens and forms. Able to speak clearly in conversations and general communications. Hearing ability for communication in persona, phone, and/or other electronic methods. Manual dexterity for typing and writing. Manual dexterity to assist members with paperwork and daily functions. Able to stoop, squat, reach, pull, push, stretch, ascend and descend stairs, stand and sit for long periods of time. May be required to work additional hours or days depending on circumstances. 

Additional Information: This job description is not intended to be an exhaustive list of all possible duties, skills, job knowledge, responsibilities, and/or qualifications. EBF reserves the right to revise the job description or to assign other duties to this position. This job description is not intended to create a contract or property right to continued employment between the employee and EBF. 

Easterseals Blake Foundation and Aviva are an Equal Employment Opportunity and Affirmative action employer that promotes a work environment of inclusion and diversity. We are committed to provide employment opportunities to all candidates based on their qualifications free of discrimination based on race, color, religion, national origin, sex (including pregnancy, sexual orientation or gender identity), age, disability, veteran status, genetic information, mental or physical disability, or any other characteristic protected by law.

If you have any questions, require assistance or reasonable accommodations while seeking employment, please contact the Human Resource Department at [email protected] or call 520-327-1529 ext. 7000.