We’re looking for an experienced Eligibility Specialist who is passionate about improving the landscape for mental healthcare. This position will help directly improve our Pre-Service operations and expand access to care. You will be responsible for all aspects of our eligibility processes to ensure client coverage is verified prior to care. You will report directly to a Team Lead on our Eligibility team to streamline eligibility workflows, identify opportunities for improved processes, and ensure care is covered prior to service. You will also work closely with our Customer Support teams to assist with provider or client questions related to eligibility. From day one, you’ll get exposure to what it’s like to build a business from the ground-up and you’ll be able to drive real impact.
What You’ll Be Doing:
- Utilize clearinghouses like Availity and Claim MD, along with payer portals, to verify patient eligibility and benefits, ensuring accurate claims submission.
- Investigate and resolve eligibility-related denials by researching coverage details and correcting discrepancies.
- Complete outbound calls to insurance carrier representatives and supervisors to investigate denial reasons.
- Resubmit claims with errors, utilizing knowledge of CMS 1500 forms and a broad understanding of data, coding, and policy errors.
- Draft appeals for relevant claim denials, adhering to medical policies for all insurance carriers
- Ensure patient data in software is correct and most up to date, contacting the appropriate person for any inconsistencies.
- Prioritize workflows based on age of claims.
The salary range for this position is $47,000.00 - $61,000.00 USD.
You’ll Be a Good Fit If:
- Process-Driven: Highly organized, operational thinker, rarely leaving questions unanswered.
- Adaptable: You are comfortable in a fast-paced environment, with priorities changing weekly.
- Healthcare Experienced: Strong understanding of healthcare claims, plan benefits, and patient responsibilities. At least 2 years of experience in Medical Billing or Healthcare setting.
- Team Player: You are collaborative by nature, relish in camaraderie and group wins, and are looked to by colleagues or direct reports as a steadfast partner & source of encouragement
If you don’t meet every single requirement, but are still interested in the job, please apply. Nobody checks every box, and Grow believes the perfect candidate is more than just a resume.
Note: Please upload your resume in PDF format
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