Eligibility Verification Specialist

PRIMARY FUNCTION: Verify insurance eligibility for future patient appointments, document eligibility notes and perform patient outreach as needed, providing excellent customer service 

ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.) 

1. Follow Pediatric Associates Eligibility Verification Quality Checklist to determine insurance eligibility 

2. Review patient insurance for future appointments and identify eligibility requirements based on health plan 

3. Use all available resources to determine insurance eligibility (e.g. system, web portals, phone) 

4. Update patient insurance details accurately 

5. Identify eligibility issues, communicate them to patients/parents and accurately document action taken 

6. Complete all assigned appointments efficiently, within the expected timeframe 

7. Communicate with office location via e-mail, Microsoft Teams and/or phone to coordinate patient callbacks for appointment rescheduling 

8. Communicate effectively with supervisor, escalating issues as needed 

9. Meet productivity standards as determined 

PERFORMANCE REQUIREMENTS: 

Education: High School Diploma or equivalent.   

Language: Must be proficient in English and Spanish

Location: Monterrey, N.L., Mexico

Experience: 1-2 years experience preferred. Must be detail-oriented and able to efficiently complete a high-volume of tasks using many sources. Excellent documentation skills required. 

Typical Working Conditions: Working in a professional office environment. Clear and concise communication using e-mail and phone is necessary. Requires manual dexterity sufficient to operate a keyboard, type at 35 wpm, operate copier, and other office equipment as necessary.