Eligibility Specialist

Open to Texas residents ONLY.

The Eligibility Specialist primarily facilitates the treatment authorization process for managed care patients (Medicare, HMO and PPO). Works under general supervision and is responsible for the coordination of patient referrals, to include submission, tracking, patient scheduling, and closing the loop on all referrals as well as the coordination of treatment for hospital and/or ancillary services. Will support the department with various clerical responsibilities as needed. Position entails communicating with Office and UM.

SPECIFIC SKILLS NEEDED

• Excellent organizational, written, and verbal communications and strong interpersonal skills
• Communicate effectively with staff, patients, guarantors, insurance companies, and physicians.
• Demonstrates attention to detail
• Good English speaking, spelling, reading, and mathematical skills required
• Must possess excellent telephone etiquette, and customer service skills.
• Proficient computer skills and knowledge in Word, Excel, Outlook, and ability to maneuver through multiple screens in a timely manner
• Ability to sort & file material correctly by alphabetic or numeric systems; computer data entry skills; ability to work effectively in fastpaced situations & tight deadlines
• Ability to stay on task in a fast and highpressured environment
• Strict adherence to all HIPAA laws
• Strong commitment to customer service with demonstrated ability to create a positive patient experience
• Demonstrates the ability to work well independently as well as part of a team
• Understanding of guidelines for commercial, senior, and MediCal requirements to expedite the treatment authorization process
• Ability to develop effective working relationships with all levels of the organization, physician offices and health plans

EDUCATION/EXPERIENCE/TRAINING

Required:

• High School diploma or GED
• Oneyear experience performing hospital or medical group related insurance verification or receptionist experience in a hospital/medical office outpatient setting

Preferred:

• Prior experience working in medical field/call center environment
• Medical terminology knowledge
• Medical insurance knowledge
• Bilingual skills (English/Spanish)

About TEXASCONNECT INC

Texas Connect, Inc. (TCI) is a Management Services Organization (MSO). ‍ As an MSO, we are dedicated to providing business and administrative services for healthcare providers, such as medical practices and hospital systems, allowing them to focus on patient care. TCI handles crucial backend functions, such as Information Technology, Billing, and Medical Coding. This allows our client healthcare organizations to delegate these and other essential, but non-medical tasks to TCI to improve operational efficiency. https://www.texasconnectinc.com