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Benefits Eligibility Specialist

Company: Positive Impact Health Centers
Location: Duluth
Posted on: March 16, 2023

Job Description:

Are you seeking a career with a growing company, a place where you can make an impact in the community? Then Positive Impact Health Centers is the company for you.

Positive Impact Health Centers (PIHC) is a community leader in providing HIV prevention, care and treatment services located in Metro Atlanta. The PIHC model of care assures that clients have access to medical, pharmacy, dental, behavioral health and social services, providing the best opportunity for patients to achieve high-quality health outcomes. Services are provided on-site and through telehealth.

What makes us different? We offer our employees the following:

---1 Health Wellness day per quarter

---Parental Leave

---Free parking at our locations/bus line accessibility

---Competitive Salary & Benefits

---Automatic 3% Safe Harbor & 2% Profit Sharing (Retirement Program)

---100% allotted for benefit elections for employees, 50% allotted for benefit elections for employee's spouse/dependent

---Credit Union

*Proof of Covid-19 vaccination is required*

JOB SUMMARY: The Benefits Eligibility Specialist is responsible for verifying insurance eligibility and benefits, addressing insurance related patient concerns, providing Federal Funded Programs to include but not limited (Ryan White & SAMSHA, etc.), other PIHC services and completing required eligibility with clients who qualify, advise patients of their financial obligations. Benefits Eligibility Specialist also provide variety of Front Office administrative duties, including but not limited to answering and directing phone calls, greeting patients, collecting copayments, maintaining patient accounts by obtaining, recording, and updating personal and financial information.

This position description should not be interpreted as all inclusive. It is intended to identify the major responsibilities and requirements of this position. The incumbents may be requested to perform job-related responsibilities and tasks other than those stated in this position description.



Duties and Responsibilities

  • Verify insurance on scheduled patients to ensure eligibility and benefits are effective in order for accurate timely claim submission and payment.
  • Input demographic information, billing information and insurance into medical management system.
  • Process intake forms and verify insurance benefits and or financial obligation for all new clients.
  • Utilizes the online eligibility verification system, and/or may have to contact Payer directly via telephone, and/or access payer website.
  • Assists client with any health care plan questions, concerns or issues to ensure that any problems are identified and necessary corrections are made in time to prevent or minimize delays in the client receiving coverage.
  • Communicate with patient regarding patient's insurance benefits, financial responsibility per sliding fee schedule, and to ensure Front Office is able to collect moneys such as copays.
  • Conduct financial assessments for designated patients as described in the policy and procedure.
  • Verify insurance benefits for all new patients, upon change of insurance coverage, and/or an annual basis. Document covered benefits on the insurance verification form.
  • Educate clients regarding all financial and insurance benefits, government funds, grant, and drug reimbursement programs. Ensure all requirements are met.
  • Assist in billing and collection of patient accounts.
  • Must have experience with all payer types: Commercial, Medicare, Medicaid, HMO, etc.
  • Collects all supporting documentation for Federal funded services eligibility and ensure that all documentation is uploaded in the system.
  • Complete Ryan White annual and 6-month certification processes to ensure that clients are eligible to receive services
  • Call and ensure that clients receiving Federal funded services are aware of the dates/times that their certifications are scheduled and ensure that clients are reminded of the documentation required of them for certification/eligibility.
  • Assist patient in managing the sliding fee scale and determining annual cap on charges as required by Ryan White program
  • Ensure that Release of Information (ROI), HIPPA and Patient Consent are obtained on all patients, updated as needed and scanned in the patient's Electronic Medical Record (EMR).
  • Fax all medical records requests and follow-up to ensure receipt of requested records.
  • Performs all other related duties as assigned. Knowledge, Skills, and Abilities
    • Knowledge of HIPAA laws.
    • Knowledge of Ryan White or other grant requirements.
    • Knowledge of basic bookkeeping
    • Knowledge of the procedures and practices for receiving, disbursing and depositing cash.
    • Knowledge about confidentiality regarding communicable/infectious disease issues (HIPAA guidelines)
    • Knowledge of the basics of HIV transmission, disease process and prevention.
    • Ability to deal with the public in a tactful and courteous manner.
    • Ability to establish and maintain effective working relationships with others
    • Ability to communicate effectively.
    • Basic Knowledge of Ryan White HIV/AIDS program is essential
    • Ability to collect, synthesize and research complex or diverse information.
    • Ability to establish and maintain effective working relationships with a variety of clients who are living with HIV/AIDS in order to collect, verify, organize and analyze information to determine eligibility for health insurance coverage
    • Must be able to demonstrate ethical behavior in diverse situations and use critical thinking skills.
    • Attention to detail and meeting timelines is required.
    • Ability to adapt and work successfully in a high stress constantly changing environment.
    • Ability to manage time efficiently, prioritize tasks, maintain complex client records and document and compile client data related to health insurance and other public or private benefit programs.
    • Ability to make independent decisions in accordance with health benefit or public benefit programs rules and regulations, and organization policy.
    • Strong computer skills
      Minimum Qualifications

      A high school diploma or GED Equivalent and one year of clerical experience in a medical environment. College degree preferred.


      Minimum 1 to 2-year experience in Healthcare Customer Services, insurance verification, and/or experience in providing Federal funded services. Experience in medical records and/or medical data entry required.

      Preferred Experience

      Spanish Bilingual preferred

      Valid State Driver's License

      Salary Description


Keywords: Positive Impact Health Centers, Roswell , Benefits Eligibility Specialist, Other , Duluth, Georgia

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