Sr Eligibility Verification and Benefit Specialist

OneOncology is positioning community oncologists to drive the future of cancer care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

The Sr. Eligibility Verification and Benefit Specialist are responsible for verifying and maintaining insurance coverage in all patient accounts for all lines of business. Obtains and monitors referrals for patients when needed, including specialized referrals such as out of network or out of area referrals. Communicates with patients and other departments regarding patient coverage and liability. Sr. Eligibility Verification and Benefit Specialist work to resolve all Eligibility and Coordination of Benefit Denials in Unity.

Responsibilities: • Runs daily reports to monitor and obtain authorizations and/or referrals required by the insurance carrier for patient visits, including out of network or specialized referrals as required. • Verifies and loads existing patient insurance changes by completing an insurance verification form for each patient. Locks the MAR in the electronic medical record and communicates changes to the necessary teams including authorization and patient assistance teams. • Ensures referrals are in place for other teams to obtain the appropriate authorization. • Receives and replies to all instant messages with the Front Office related to patients changes of insurance, copay questions, coverage and any process/procedure questions in a timely manner. • Works all emails regarding coverage from all other teams. • Works with the patient to ensure any coordination of benefits issues are handled according to policy and procedure to ensure appropriate and timely processing of claims. • Works all insurance denials relating to patient insurance coverage, premium payment, pre-existing, and relays provider participation issues to the credentialing department. • Sr. Eligibility Verification and Benefit Specialist is responsible for entering all departmental copays and gathering the ded/oop accumulations. • Monitors Pending Cobra accounts to ensure policy is active and the patients claims will be processed and paid appropriately. • Document all changes made to the account in the practice management system. Providing detailed, accurate and well thought out notes. • Makes insurance changes, relating to research, transplant, SNF, Hospice in Practice Management system and EMR system documenting in the required templates in the patient’s chart. • Coordinates and communicates information required or requested by other teams within the mandated timeframe. • Ensures up-to-date documentation on patient accounts on follow up or ongoing transactions. • Works any eligibility payer denials to ensure claims can be paid timely. Including reaching out to the patient, insurance and possibly the employer. • Works any Coordination of Benefit denials to ensure claims are paid timely and correctly. Including reaching out to the patient, insurance and possibly the employer. • Follows policy and procedures outlined by management to ensure standardization of processes. • Notifies Eligibility Verification and Benefit Management of any issues that potential for a negative outcome for the organization.

Required Qualifications:

EDUCATION & EXPERIENCE:
• High School diploma or equivalent.
• One year experience in a directly related role preferred, but not required.

Essential Competencies:
• Attendance is an essential job function.
• Ability to work effectively with all levels of management and other colleagues
• Ability to demonstrate initiative and mature judgment.
• Ability to demonstrate high degree of professionalism and adaptability.
• Ability to demonstrate proficiency in the use of end-user computer applications (MS work, Excel, Outlook), database and patient scheduling and other medical information systems.
• Ability to demonstrate strong customer service delivery skills.
• Ability to utilize websites, portal and electronic options when available to increase efficiency
• Ability to follow oral and written instructions.
• Ability to recognize and solve problems using creative thinking skills, hands on problem solving skills and the ability to analyze and respond to data.
• Skilled at effective verbal and written communications, including active listening skills and skill in presenting findings and recommendations.
• Skilled at Multi-tasking, organizational skills and superb attention to detail.
• Working knowledge of Hospice and other payer requirements.
• Knowledge of clinic office procedures, medical practice and medical terminology.

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