Eligibility Referral Specialist

Job Description

Eligibility Referral Specialist

Ridge, NY

New York Cancer and Blood Specialist (NYCBS), the best in Long Island cancer treatment: a comprehensive community oncology center delivering more personalized services and faster access to technologies and treatments.

In this role you will:

Verify insurance benefits including primary, secondary, and tertiary. Obtain all pertinent information of out of pocket, co-insurance, deductible, co-pay, and if referrals / authorization are required for services.

Update systems (both OncoEMR and practice management Centricty) of any insurance changes that are made. Verify newly entered benefits into practice management system. Work with front staff to obtain new insurance cards and demographics every 3 months.

Obtain referrals for office visits, labs, radiology, and chemotherapy and radiation therapy.

Run daily business office activity report to work the Referral required and Insurance Issue statuses. This report will be run several times daily. All patients must be approved by end of day. Any patient’s that do not have a completed status by 3pm EST must be reviewed with manager to determine if appointment should be rescheduled.

Work daily Visit Owner: NYCS Eligibility (Commercial) & NYCS – Referral. All tickets must be touched and/or worked within 24-48 hours. Appropriate visit descriptions are required to be listed, corr notes added, and follow-up performed in a timely manner.

Coordination of Benefit (COB) letters are to be mailed to patients when phone contact (3x) has been unsuccessful. Sent letter must be documented in patient’s chart.

Answer calls from insurance and patient’s on questions for claims and/or patient balance.

Review and explain patient’s statements and their financial responsibility. Work account as necessary and/or set up a signed payment plan with the patient.

Refer to Financial Counselor if patient balance is for treatment with drugs and possible need patient assistance.

Work closely with third party vendor Fedora to ensure authorizations are in place and insurance benefits are accurate.

Obtain referrals / authorizations for any add on treatment same day.

Maintain and ensure the confidentiality of all patient and employee information at all times.

Be expected to work when given sufficient notice of required overtime.

We require:

A High School diploma

Experience working in the healthcare field, preferably in a clinical setting or business office

Experience in insurance requirements and medical terminology ICD-10 and CPT coding

Excellent oral and written communication skills

Ability to accept direction and work within a team concept

Typing and computer skills

Strong customer service skills.

Previous experience preferred.

Hours: Monday–Friday

Salary up to $26 and benefits including Tuition Reimbursement, Health Insurance on day 1 of employment, Dental, Vision, Life Insurance, Short and Long term disability, 401k Plan, generous PTO time, 8 paid holidays (2 floating) and more

Visit our website at: nycancer.com and follow us on Facebook.

New York Cancer and Blood Specialists is an Equal Opportunity Employer.

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