Eligibility and Enrollment Specialist

Seth Klein with A-Line Staffing is seeking an experienced Eligibility and Enrollment Specialist for an Oncology Clinic in The Woodlands,TX

Pay: $20.00 to $21.00 p/hr D.O.E

Clinic Hours: Monday - Friday 8:00am to 5:00pm

Job Description:

The Oncology Eligibility Coordinator conducts and assists in all aspects of both determining eligibility and enrolling patients into programs by executing the following duties:

• Reviewing and understanding the contractual requirements that determine eligibility for this program, navigating through medical records and practice management systems in addition to internal Innovent IT systems, and utilizing understanding of Oncology terminology and critical thinking to gather data to summarize the treatment plan for each patient to complete enrollment. Additional job functions include:
• Providing completed work each day to the payer, answering questions from the payer about enrolled patients and marking outcomes of eligibility into the Innovent IT system.
• Understanding the basic rules for Billing the episodes in order to communicate well with the Practice billing department.
• Maintaining various reports / spreadsheets, supports and adheres to the McKesson Compliance Program, to include the Code of Ethics and Business Standards as well as all HIPAA protocols and client contractual obligations.

Key Responsibilities (List the top five to seven essential responsibilities in priority order):

• Assists in all aspects of determining patient eligibility for Innovent programs:
• Follows specific contract requirements-must understand details of contracts
• Navigate through multiple IT systems
• Review of Electronic Medical Records for active treatments and plan of care
• Understanding of Oncology Chemotherapy treatments ( IV/Oral /Hormonal)
• Verification of insurance benefits
• Responsible for understanding basic billing rules for episodes
• Understanding of different Payment Conditions
• Communication with Provider and Payers
• Answer questions from Payer about eligibility and Payment conditions
• Discuss with Provider basic rules for billing of episodes
• Work with Analytics team regarding gathered data
• Assist in all aspects of enrolling eligible patients into Innovent Programs:
• Document in Innovent IT systems
• Populate all required information into the Payer Spreadsheets
• Outreach to provider to obtain missing clinical data
• Populate all data on Master Spreadsheet
• Assist with reviewing patients as needed for payer and provider audits of enrolled patients.

Requirements:

• Need clinical experience
• Experience with medical chart review, oncology experience, insurance verification and medical billing.
• Should be familiar with medication types; oncology drugs included, able to navigate EMR, read Doctor notes and look into patient care plans.
• Experience documenting in patient chart.
• Will be part of a larger (20+ people) team and should be able to work well with team including taking direction, learning / following an outlined process
• Historically people from lead / management roles have not been successful in this position.
• Must be able to have set up/office at home. position is remote at this time due to COVID.
• Will be intense online training via webex. Must have dedicated space to work at home with no distractions.
• Work day 8-5. Must have high speed internet access with not interruptions during the day.