As an Eligibility Representative, the individual will perform a detailed in-house review, and determine if the patients are viable candidates for the state, county, medical, federal, or disability assistance or not. The job description includes performing necessary investigative, administrative, and fieldwork and also assist patients in meeting the eligibility requirements as needed. The job duties listed on the Eligibility Representative Resume include – screening patients to determine potential eligibility; explaining patients the eligibility requirements, and application processes; facilitating the application processes when appropriate; documenting pertinent information; monitoring patient accounts; and maintaining confidentiality pertaining to the health records of patients.
While hiring for this role, employers look for the following skills and abilities – knowledge of maintaining the confidentiality of patient account; good understanding of contents of the employee handbook; knowledge of medical assistance application process; and skillful in reading documents. Eligible candidates are expected to have a college degree in the field of healthcare administration or the related.
Objective : To obtain a challenging and rewarding position in a well rounded company.Provide specialized assistance, counseling and individualized guidance concerning the Uniformed Services Health Benefits Program (USHBP) including the TRICARE managed health care program.
Skills : Management, Organizing.
Description :
Responsible for adding, terming, and reinstate members to health insurance policies.
Adjudicates and pends enrollment applications and issues in accordance with most policies, limitations, or exclusions through automated queue.
Investigates and adjudicates enrollment pended documents in conjunction with underwriting and appeals for denials or approval of enrollment for prospective or current members on health insurance policies.
Resolves previously suspended enrollment pends through automated work queue.
Resolves complex enrollment issues and works closely with employer groups and brokers for resolution.
Communicates policies, procedures, and benefits to employees, enrolled members, and employers.
Interacts with staff in other departments to clarify and resolve eligibility problems presented by members.
Maintains accurate eligibility records for individuals and/or assigned employer groups.
Processes all enrollments, plan changes, and disenrollment transactions.
Experience
2-5 Years
Level
Junior
Education
Bachelor's
Sr. Eligibility Representative Resume
Objective : To secure a staff/administrative support position with a world class customer service organization in the areas of insurance, call centers, healthcare services, or any other organization where talents, skills, and experiences will make a positive impact in the business.
Skills : Management, Organizing.
Description :
Worked on the Programs Department evaluating immigrant children's documents to verify if they qualify for Government Aid Programs.
Loaded and updated immigration status information on children's accounts.
Made and received calls from parents, to request more documentation required for the evaluation, and/or provide feedback of the status or the results of it.
Audited the third party administrator regarding immigration procedures.
Assisted other areas to verify if the translation of letters from English to Spanish were correct.
Worked on Special Projects.
Answered the phones to assists beneficiaries (Parents) concerns or questions.
Informed parents about their accounts.
Experience
2-5 Years
Level
Junior
Education
B.A.
Jr. Eligibility Representative Resume
Objective : Seeking a Eligibility Representative position where can use traning, skills and strong work ethic to contribute to the success of the company.
Skills : Microsoft Office, Customer Service, Benefits Administration.
Description :
Verified patient's insurance eligibility from insurance websites.
Called insurances, facilities and patients.
Added and updated insurance set.
Edited transactions and transferring balances.
Entered insurance codes from contract table.
Corrected and reposted charges.
Submitted claims to payers Rebilling Entering DTS/denial codes.
Pulled EOBs to verify patient billing information and reasons of denial.
Pulled face sheets to verify demographics and insurance information.
Experience
2-5 Years
Level
Junior
Education
Bachelor's
Eligibility Representative I Resume
Objective : A position that offers the opportunity for advancement. Provides individual counseling and assistance concerning beneficiary problems and related benefits that may be available under other programs.
Skills : Microsoft Office, Leadership, Communications, Project Management, Process Improvement.
Description :
Screened uninsured patients and provided guidance on federal/state/charity programs they may qualify for to assist in meeting their financial obligations.
Responsible for preparing weekly inventory reports, employee production reports, and performing quality and employee reviews.
Facilitated weekly staff meetings, provided staff work lists, attended weekly client meetings, and responded to client and employee inquiries.
Billed and collected aged receivables for in and out-of-state hospitals.
Trained new associates on multiple hospital systems and the financial recovery processes.
Assisted 100 uninsured patients with applying for financial assistance each month.
Successfully led the accounts receivables collections for Duke University, completing over 150,000 accounts valued in excess of $100 million.
Led the accounts receivables collections for Norton Healthcare collecting $1 million in aged receivables monthly.
Experience
2-5 Years
Level
Junior
Education
MBA
Eligibility Representative II Resume
Headline : Representative skilled at resolving complex customer service issues in a timely manner. Solid team player with an upbeat and positive attitude. Effectively identifies problems using advanced troubleshooting skills. Highlights Troubleshooting proficiency Exceptional telephone etiquette Patient and diligent Exceptional customer service Reliable Excellent communication skills Energetic Approachable Flexible Team player Strong work ethic Organized.
Conducted 250-400 individual, family and couples interview sessions per month.
Directed all case management & parent education.
Interviewed clients individually and with families to determine what services would best address their needs.
Advised patients on community resources, made referrals and devised realistic treatment plans.
Assessed client and delivered comprehensive case management services.
Communicated with public social and welfare agencies to obtain and provide information.
Facilitated 10-12 group class sessions per week.
Evaluated and addressed individual client needs and concerns.
Conducted health assessments for children, adolescents and adults receiving child welfare and prevention services.
Experience
5-7 Years
Level
Executive
Education
Diploma
Eligibility Representative III Resume
Headline : To work for an organization as to where Eligibility Representative experience and background can be utilized.
Skills : Management, Organising.
Description :
Processed and maintained eligibility information for routine individual and or employer groups Under direct supervision.
Maintained accurate eligibility records for assigned line of business.
Entered system eligibility data on a daily basis, including new enrollees, changes and cancellations.
Conducted periodic audits of group eligibility data.
Reconciled group eligibility, report to monthly statements.
Responded to all written and telephone eligibility inquires from individuals or assigned employer groups.
Researched information on subscribers to resolve problems and disputes.
Maintained quality and production standards as outlined by the department.
Assisted with special projects.
Experience
5-7 Years
Level
Management
Education
Diploma
Asst. Eligibility Representative Resume
Objective : To obtain a Eligibility Representative position within a field that is meaningful and challenging; which also contributes to daily knowledge and growth as professional.
Skills : Management, Organizing.
Description :
Assisted patients with the completion of applications for all qualified programs.
Scheduled appointments on the patient's behalf with the appropriate agency.
Followed up with the agencies to ensure submitted applications are processed in a timely manner.
Assisted in appealing denied applications.
Acted as a liaison between the patient and the agency during the application process.
Continued to follow up with all accounts in specified inventory.
Updated the hospital and company systems with current activity.
Submitted verified billing members to the client.
Experience
2-5 Years
Level
Junior
Education
BA
Associate Eligibility Representative Resume
Headline : Self-motivated and driven with strong problem-solving, decision making, and organizational skills Supervising a staff of 10 +. Strong communication skills and ability to build relationships easily with others.
Skills : Management, Organizing.
Description :
Answers phone calls in a professional and courteous manner, taking appropriate action.
Utilizes screening and determining forms to assist self-pay patients in applying for possible eligible programs and financial aid.
Assists patients in completion of all applications and maintain a high level of accuracy on all forms.
Conducts visits to patients' home and local agencies to conduct screening interviews, complete applications, gather necessary verification documents, drop off applications, and check status of applications.
Enters correct patient data into the computer terminals.
Reviews and follows-up on patient accts in a timely manner.
Maintains and updates all patient accts to reflect current information in a timely manner.
Collects and arranges for payment by patient or responsible party.
Experience
5-7 Years
Level
Executive
Education
Bachelor's
Lead Eligibility Representative Resume
Summary : Ability to handle multiple tasks while meeting department time lines. Over 10 years of experience in Customer Service and Office settings. Good eye for detail; well organized, skilled in setting priorities. Proper Telephone Etiquette to handle Customers and Clients efficiently and effectively.
Skills : Customer Service, Data Entry, Computer Literate, Interpersonal & Great Communication .
Description :
Managed discrepancy reports pertaining to employee eligibility for numerous employer groups.
Maintained records on spreadsheets and on files and met internal deadlines.
Resolved eligibility issues/inquiries via email and telephone in a timely manner.
Daily used of office equipment: scanner, fax, copy machine and telephone.
Uploaded electronic data information using strict attention to details.
Managed the departments email inbox and delegate emails to the correct Eligibility Rep.
Kept employee records up to date with accurate information.
Experience
10+ Years
Level
Senior
Education
Bachelor's
Eligibility Representative Resume
Headline : Empathic, e ective, and motivated professional who combines clinical experience and great education with compassion to meet the challenges facing today's healthcare organizations. Clear awareness of diverse backgrounds, alert to widely varied patient needs and circumstances. Collaborative team player, acting as key resource to colleagues and allied health professionals.
Skills : Management, Organizing.
Description :
Maintains accountability of SCI information in the facility to include establishing, monitoring, and training personnel on a system to record the receipt, generation, reproduction, transmission, and destruction of all SCI material as required
Coordinates and clears local facility meetings and visits
Providing access to the SCIF for those who are SCI indoctrinated
Coordinates SSO approval for information and/or IT equipment entering or departing the facility
Works with SSO and FIS Security & Facilities to ensure continuous alarm coverage and periodic maintenance and testing
Establishes emergency coverage plan with facility occupants to cover IDS outages
Completes timely follow-up and effectively communicate with members and providers.
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