Job Description

The Eligibility Specialist is responsible for contacting insurance companies to verify a patient's coverage and eligibility for home healthcare services, ensuring accurate billing by confirming details like benefits, copay amounts, and service limitations, all while adhering to HIPAA regulations and company policies; this role typically involves utilizing dedicated software to manage patient information and insurance verification processes. 

This role is a remote hybrid position where you will work from home but are required to come into the office for any required trainings or in-person meetings.

Essential Job Functions

• Contacting insurance companies:

Calling insurance providers to verify patient eligibility and coverage for requested home healthcare services. 

• Data entry:

Accurately entering patient and insurance information into the company database. 

• Benefit verification:

Confirming details like copay amounts, deductibles, and service limitations for each patient's insurance plan. 

• Eligibility checks:

Assessing if a patient meets the criteria for covered home healthcare services based on their medical diagnosis and insurance policy. 

• Prior authorization requests:

Initiating prior authorization requests for specific treatments or services when necessary. 

• Patient communication:

Explaining verification process to patients and addressing any questions regarding their insurance coverage. 

• Claims submission support:

Providing accurate patient and insurance information to the billing department to facilitate smooth claims submission. 

• Compliance with regulations:

Adhering to HIPAA guidelines to protect patient privacy. 

Requirements
• High school diploma
• 2+ years of related experience
• Strong computer skills (Word, Excel, Power Point)

Remote and hybrid work is limited to the United States only, and in states where Aveanna conducts business. Remote workers should be prepared to come into the office periodically.

HHH

As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.

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