Harlem United Eligibility Specialist in new york, New York


The primary task of an eligibility specialist is to verify patient eligibility, coordination of benefits, and determining patient coverage/responsibility for services. This may require specialists to follow up with applicants a number of times. In addition to preparing and maintaining client files, they must keep track of client appointments and any changes in the policies of their organization contract with each insurance plan.


The following duties are mandatory requirements of the job:

• Enter demographic and client information into the electronic medical record and understand how to properly navigate through the system in order to manage client information.
• Utilizes all available resources to obtain and enter insurance coverage information into patient’s file needed to bill medical, clinical and other services provided.
• Facilitates and completes the prior authorization process with insurance companies and/or practitioner offices for adequate billing prior to a patients appointment.
• Notifies patients and/or clinics front office of any financial responsibility (ex. deductible or co-pay) of services to be provided by the facility.
• Update patients account in system with any action taken or additional information attained when verifying benefits such as creating case logics.
• Assist and respond to billing staff and patient billing questions, issues and/or concerns.
• Follow up on denied claims due to patients’ inactive coverage response and pcp changes.
• Attend meetings and trainings with or for the clinic staff, physicians and billing department.
• Performs other FQHC department related duties as assigned or requested.


• 1-2 years’ experience in medical office front desk and/or billing practices preferred.
• Knowledge of ICD-9, ICD-10 and CPT codes.
• Able to safeguard sensitive confidential agency and staff information.
• Strong telephone customer service skills.
• Familiarity with third party private payer practices.

• High School Diploma or GED.
• Medical Billing and Coding certificate preferred.


In addition to the above-listed job responsibilities and educational requirements, the ideal candidate for this position possesses most or all of the following:
• Strong interpersonal skills with written and communication skills.
• Must have general computer skills.
• General knowledge of internet navigation and research and medical billing.
• Ability to work independently and manage time effectively.