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Eligibility Reviews Specialist Jobs

Reviews Editor Jobs
By Valnet At Virginia, United States
Relevant experience in editing (2+ years) in the English language
Expert knowledge of technology products and a history of review technology products
This position will operate on a remote, freelance basis.
Applicants must have a self-starter attitude and possess the following requirements
Overseeing the reviews content and maintaining author relations
Editing and reviewing the work of authors
Eligibility Specialist Jobs
By ReviveHealth At United States
Ability to multi-task using multiple computer systems with strong organizational and time management skills
Performs other responsibilities as assigned
One year of enrollment data or other related work experience
Beginner Excel experience required, Intermediate preferred
Demonstrated attention to detail and analytical skills relating to reconciling and problem-solving using data
Previous experience working with health insurance or in a health care environment preferred
Eligibility Specialist Ii (Sr-Non-Magi) / 60017385
By State of South Carolina At Horry County, SC, United States
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
State Retirement Plan and Deferred Compensation Programs.
Overtime and/or weekend work with Deputy approval.
Sitting or standing for long periods of time.
Eligibility Specialist Ii (Ltcw) / 61100336Tg
By State of South Carolina At Columbia, SC, United States
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
State Retirement Plan and Deferred Compensation Programs.
Overtime and/or weekend work with Deputy approval.
Sitting or standing for long periods of time.
Eligibility Specialist Ii (Non-Magi) / 61062018
By State of South Carolina At Lexington County, SC, United States
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
State Retirement Plan and Deferred Compensation Programs.
Overtime and/or weekend work with Deputy approval.
Sitting or standing for long periods of time.
Insurance Eligibility Specialist Ii
By Brightside Health At United States
Have good organizational, multi-tasking, and time management skills, with excellent attention to detail.
Have advanced Excel skills, with the demonstrated ability to write formulas, perform VLOOKUP, pivot tables, etc.
Have knowledge of EDI 270/271 transactions and insurance eligibility verification Have strong work ethic, resourcefulness, and the motivation to succeed
Have experience working with insurance companies in the healthcare provider industry
3-5 years previous experience in medical billing, current A/R & experience in patient services a plus.
Maintain knowledge of industry standards for insurance verification Understand and adhere to HIPAA policies, procedures, and regulations, maintaining strict confidentiality
Eligibility Specialist Jobs
By Texas Children's Hospital At Greater Houston, United States
2 years previous experience working at or with an HMO or MCO organization required
A bachelor’s degree may substitute for the years of required work experience
Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
High school diploma or GED required
Manually update member eligibility data in the claims processing system using multiple sources for reference, including applications, databases, and reports
Research and resolve member eligibility issues thoroughly, timely, and accurately
Medical Director, Clinical Reviews
By Point32Health At , Remote
Utilization management, quality and / or management experience, is strongly preferred.
EDUCATION and EXPERIENCE: (Minimum educational qualifications)
Have an understanding of principles of utilization management and quality assurance.
Assist with regulatory requirements including external and internal audits and monitoring
Minimum of five years of clinical experience is required.
Be an effective team player, with excellent interpersonal, cross-departmental and leadership skills.
Eligibility Specialist Jobs
By NYC HRA/DEPT OF SOCIAL SERVICES At , Manhattan, 10048, Ny $40,062 - $59,390 a year
Provide information about transitional benefits to encourage financial independence through employment.
Maintain a caseload by managing time effectively including Face-to Face recertification interviews, participants’ appointment schedules, processing paperwork, training and meetings.
Complete agency forms to facilitate the appropriate issuance of benefits and participants notification.
Benefits Access Center (BAC) East End; 2322 Third Avenue, New York, NY 10035
Identify and provide special and or emergency needs in a timely manner.
Accurately complete Fair Hearing/Aid to Continue compliance and resolutions within prescribed deadlines.
Eye Care Program Eligibility Specialist
By Lumata Health At Oklahoma City, OK, United States
Experience in a phone-based reception environment, preferred.
Outstanding communication skills, both written and verbal.
Ability to work remotely with reliable Wifi access.
Collecting and analyzing patient information for determining eligibility for an eye care support program.
Determining initial and ongoing eligibility for the eye care program in accordance with established procedures.
Maintaining accurate records of patient eligibility activities, as well as departmental operations in compliance with HIPAA and other regulatory guidelines.
Integrated Services Specialist - Eligibility, Billing And Recon
By CVS Health At , Hartford, Ct $17.00 - $27.90 an hour
General knowledge and understanding of Marketplace Insurance, or exchange business.
Experience with problem solving and process improvement initiatives.
Background in Enrollment and Eligibility and/or Accounts Receivable.
Excellent verbal and written communication.
High data integrity and accuracy within processes.
Ability to work in a fast paced and deadline driven environment.
Eligibility Specialist Ii (Non-Magi) / 61061959
By State of South Carolina At Charleston, SC, United States
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
State Retirement Plan and Deferred Compensation Programs.
Overtime and/or weekend work with Deputy approval.
Sitting or standing for long periods of time.
Unit Eligibility Specialist Jobs
By Washington County, OR At , Hillsboro, 97124, Or $4,486 - $5,451 a month
Three (3) years of work experience in building inspection, property management, building maintenance, or residential construction.
Accommodation under the Americans with Disabilities Act
Part-time regular, variable hour, and temporary positions are not eligible for medical, dental, and vision benefits.
Check Out Our Award-Winning Benefits & Wellness Program!
Possession of a high school diploma or equivalent; AND
Must possess a driver's license valid in the State of Oregon and have an acceptable driving record.
Eligibility Specialist Jobs
By INNOVATIVE INTEGRATED HEALTH INC At , Bakersfield, Ca $20 - $25 an hour
Proficient knowledge of computer skills, including Microsoft Office (Word, PowerPoint, and Outlook)
Minimum of two (2) years of professional experience in managed care organizations, required without an Associate’s Degree
Knowledge of general office procedures, equipment, and filing systems
Experience in the health care field, preferred
Associate’s Degree, required without professional experience
Track eligibility/enrollment changes daily for documentation purposes
Special Programs Eligibility Specialist - 05112023-45863
By State of Tennessee At , Nashville, 37243, Tn $42,504 a year
Leads documentation and management of enrollee changes to Managed Care Organization rosters to ensure accurate information is reflected for benefits.
Identifies inconsistencies and errors in policies, rules, procedures and suggest corrective action to management.
Maintains professional working relationships with peers and with upper management to ensure smooth and effective team operations.
Utilizes acquired knowledge and skills to improve daily performance of assigned tasks.
Coordinating with upper management, peers, and assigned subordinates to facilitate equitable workload distribution.
Substitution of Experience for Education:
Eligibility Specialist Trainee/I/Ii
By County of Riverside At , Riverside, Ca

Qualifying experience must be detailed on your resume and/or application.

Schedule: Evening shift 3:00 pm-11:30 pm Monday-Friday

Eligibility Specialist Ii (Sr-Magi) / 60015661
By State of South Carolina At Lexington, SC, United States
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
State Retirement Plan and Deferred Compensation Programs.
Overtime and/or weekend work with Deputy approval.
Sitting or standing for long periods of time.
Eligibility Specialist Ii (Non-Magi) / Tg61088148
By State of South Carolina At Columbia, SC, United States
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
State Retirement Plan and Deferred Compensation Programs.
Overtime and/or weekend work with Deputy approval.
Sitting or standing for long periods of time.
Eligibility Specialist Ii (Magi) / 60017139Rp
By State of South Carolina At Clarendon County, SC, United States
This position is a repost. Previous applicants do not need to reapply. *
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
State Retirement Plan and Deferred Compensation Programs.
Overtime and/or weekend work with Deputy approval.
Eligibility Specialist Ii (Magi) / 61100189
By State of South Carolina At Spartanburg County, SC, United States
This is a Temporary Grant position.*
Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
15 days annual (vacation) leave per year.
15 days sick leave per year.
State Retirement Plan and Deferred Compensation Programs.
Overtime and/or weekend work with Deputy approval.

Are you looking for an exciting opportunity to use your skills to make a difference? We are looking for an Eligibility Reviews Specialist to join our team and help us ensure that our clients receive the best possible service. You will be responsible for reviewing and verifying eligibility for services, providing customer service, and ensuring compliance with applicable regulations. If you are detail-oriented, have excellent communication skills, and are passionate about helping others, this could be the perfect job for you!

Overview:

Eligibility Reviews Specialists are responsible for ensuring that applicants meet the eligibility requirements for a particular program or service. They review applications and other documents to determine if applicants meet the criteria for acceptance. They also provide guidance and assistance to applicants to ensure that they are able to meet the eligibility requirements.

Detailed Job Description:

Eligibility Reviews Specialists are responsible for reviewing applications and other documents to determine if applicants meet the eligibility requirements for a particular program or service. They must be knowledgeable about the eligibility criteria and be able to interpret and apply it to each individual case. They must be able to communicate effectively with applicants and provide guidance and assistance to ensure that they are able to meet the eligibility requirements. They must also be able to document their decisions and provide detailed reports to management.

What is Eligibility Reviews Specialist Job Skills Required?

• Knowledge of eligibility criteria and regulations
• Excellent communication and interpersonal skills
• Ability to interpret and apply eligibility criteria
• Ability to provide guidance and assistance to applicants
• Ability to document decisions and provide detailed reports
• Computer literacy

What is Eligibility Reviews Specialist Job Qualifications?

• Bachelor’s degree in social work, public administration, or a related field
• Previous experience in a similar role
• Knowledge of relevant laws and regulations

What is Eligibility Reviews Specialist Job Knowledge?

Eligibility Reviews Specialists must have a thorough knowledge of the eligibility criteria and regulations for the program or service they are reviewing. They must be able to interpret and apply the criteria to each individual case. They must also be knowledgeable about relevant laws and regulations.

What is Eligibility Reviews Specialist Job Experience?

Previous experience in a similar role is preferred for Eligibility Reviews Specialists. Experience in social work, public administration, or a related field is also beneficial.

What is Eligibility Reviews Specialist Job Responsibilities?

• Review applications and other documents to determine if applicants meet the eligibility requirements
• Provide guidance and assistance to applicants to ensure that they are able to meet the eligibility requirements
• Document decisions and provide detailed reports to management
• Monitor changes in eligibility criteria and regulations
• Maintain accurate records of all applications and decisions