Eligibility Denial Specialist

Overview:

Eligibility Denial Specialist: The Eligibility and Enrollment Specialist (EES) will provide intake and eligibility verification support necessary for the effective provision of services to clients at the Behavioral Health clinics.

Responsibilities:

• Generate scheduled intake reports for each JFCS clinic and verify information.
  
• Re-verify AHCCCS and RBHA eligibility for every intake and verify any third-party liability (TPL) or private insurance via telephone.
  
• Ensure accurate and timely billing of services provided in accordance with contract specifications
  
• Troubleshoots payment posting and balance issues within electronic medical record (EMR) system.
  
• Read and understand all aspects of an EOB/ERA; should be able to define and verbalize how the following terms pertain to the payment process: billed amount, allowed amount, deductibles, coinsurances, co-payments.
  
• Log to billing queue, Patient Eligibility Denials, Patient TPL Denials, and Patient 277 Rejection.
  
• Work denial queues worked according to creation date.
  

Key Performance Indicators* Analyze OEB’s balancing insurance and patient payments.

• Perform adjustments and credits as needed; all within a clearly defined month-end close goal.
  
• Maintain accurate monthly billing analysis reports, to include presentations.
  
• High level of analytical and problem-solving skills to accurately assign/review ICD-9-CM, CPT, and HCPCS codes to outpatient medical records.
  

Qualifications:

• High school diploma or G.E.D.
  
• Minimum 2 years� experience in healthcare billing & coding.
  
• Experience with automated billing systems.
  
• Ability to work as a part of a multidisciplinary team.
  
• Working knowledge of Microsoft Excel, Word, and Outlook
  

Benefits of Working with JFCS:* Bonus Programs for both full-time and part-time employees.

• Generous Employee Referral Bonuses up to $1,500 for both the new-hire and the referring employee.
  
• FREE Primary HealthCare to all employees and every member of their household, regardless of relationship. This includes virtual doctor's visits, physicals, lab tests, x-rays, vaccinations, prescriptions, and telehealth.
  
• Bilingual (Spanish-English) Pay Differential.
  
• Flexible Scheduling and Telehealth Flexibility for many positions.
  
• 401(k) Retirement Plan, with Company Match
  
• We offer tuition and clinical license reimbursement.
  
• Numerous professional development and career growth opportunities.
  
• Generous paid time off / sick time allocations
  
• Comprehensive Employee Benefits package, including medical, vision, dental, & more.
  
• Wellness Coaching
  
• Employee Assistance Program
  
• Eligibility for Loan Forgiveness Programs in many positions.
  

About JFCS:Jewish Family and Children’s Service’s (JFCS) values each and every talented applicant, regardless of religious beliefs, race, age, origin, gender, sexual orientation, or cultural background. JFCS places a high value on inclusion and diversity, whether that applies to our employees or the nearly 40,000 clients receiving our services throughout the Valley.