Eligibility Representative

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Full Time, Onsite, Monday - Friday

The Eligibility Representative screens referred self-pay patients for programs such as Medicare, Medicaid, Medicaid for Nursing Home Placement, Crime Victims, Vocational Rehabilitation, QMB, SSI and any/all other third party coverage including other available local, state and federal programs and the Hospital’s Financial Assistance Program;  and provides Point of Service collections for self-pay patients, patients who have balances after insurance or Medicare payments, and patients that do not qualify for any programs/coverage.  

As an Eligibility Representative at Community Health Systems, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including health insurance, flexible scheduling, 401k and student loan repayment programs.

Required:

• One (1) or more years of experience in healthcare
• One (1) or more years of experience in a customer facing environment
• Proficiency with Microsoft Word and Microsoft Excel 
• Computer Skills: Average proficiency using computers for data entry, email, web searching, etc.
• Education: High School Diploma or equivalent

Preferred:

• Working knowledge of Medicare, Medicaid, Medicaid for Nursing Home Placement, Crime Victims, Vocational Rehabilitation, QMB, SSI and any/all other third party coverage and other available local, state and federal programs preferred
• Working knowledge of HIPAA, EMTALA, and PHI
• Prior experience working in healthcare collections, hospital business office, admissions or insurance verification
• Experience in working to meet productivity metrics
• Bilingual in Spanish is preferred and additional compensation added

About the Opportunity:

• • Verifies detailed insurance benefits, medical necessity, and authorization/referral guidelines, consistently prioritizing and following the established verification processes. 
  • Communicates outstanding documentation requests, required account follow-up, and payor issues to the appropriate facility contacts.
  • Responsible for maintaining performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met while maintaining effective communication with patients, physicians, medical office staff, and both internal and external co-workers.
  • Calculates the estimated patient financial responsibility via the estimation tool.
  • Notates all actions performed in the applicable host system(s) immediately.
  • Performs all other duties, as assigned or requested, while adhering to strict deadlines

• This is a full time, onsite position at Carlsbad Medical Center in the Eligibility Screening Services Department. 

• The schedule for this position is Monday - Friday 8:30am - 5:00pm 

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

INDSSESS