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Eligibility Verification Specialist

Eligibility Verification Specialist

Solaris Health HoldingsFort Lauderdale, FL, US
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Job Description

Job Description

Description :

NO WEEKENDS, NO EVENINGS, NO HOLIDAYS

We offer competitive pay as well as PTO, Holiday pay, and comprehensive benefits package!

Benefits :

  • Health insurance
  • Dental insurance
  • Vision insurance
  • Life Insurance
  • Pet Insurance
  • Health savings account
  • Paid sick time
  • Paid time off
  • Paid holidays
  • Profit sharing
  • Retirement plan

GENERAL SUMMARY

The Eligibility Verification Specialist supports the Financial Clearance team by verifying patient insurance eligibility and benefits to ensure accurate billing, timely service, and reduced financial risk to the organization. This role ensures that all insurance-related data is accurate before patient services are rendered and maintaining efficient and compliant workflows.

Requirements :

ESSENTIAL JOB FUNCTION / COMPETENCIES

The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and / or state requirements. Responsibilities include but are not limited to :

  • Verify patient insurance eligibility, coverage, and benefit information for scheduled services using payer portals, eligibility dashboards, or direct contact with insurance carriers.
  • Confirm policy status, co-pays, deductibles, coinsurance, and authorization requirements.
  • Document all findings in the electronic health record (EHR) an / or Practice Management (PM) system accurately and in a timely manner.
  • Communicate any insurance-related issues or changes in coverage to the Supervisor and appropriate team members.
  • Collaborate with the Financial Clearance team on patient estimates and prior authorization workflows.
  • Work closely with scheduling, patient access, and billing departments to ensure seamless coordination of patient care and financial processes.
  • Follow standardized procedures and documentation guidelines as established by the Supervisor of Financial Clearance.
  • Support efforts to ensure that authorization or benefit issues do not delay patient appointments or procedures.
  • Inform patients of benefit limitations, out-of-network issues, or financial responsibility as needed.
  • Escalate complex or urgent eligibility cases to the Supervisor for review and guidance.
  • Participate in team huddles and operational meetings as directed.
  • Maintain up-to-date knowledge of payer policies and insurance plan requirements.
  • Meet individual and team productivity and accuracy goals as outlined by the Supervisor.
  • Contribute to a positive, team-oriented work environment.
  • Performs other position related duties as assigned.
  • Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and / or violations to a supervisor and / or the Compliance Department; and the timely completion the Annual Compliance Training.

    • CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

  • N / A

    • KNOWLEDGE | SKILLS | ABILITIES

  • Strong attention to detail and problem-solving abilities.
  • Effective written and verbal communication skills.
  • Proficiency in Microsoft Office and practice management systems.
  • Ability to multitask and prioritize in a fast-paced environment.
  • Knowledge of medical terminology, healthcare coding systems, and clinics functions.

    • EDUCATION REQUIREMENTS

  • High school diploma or equivalent required.
  • Associate’s degree in healthcare, business, or related field preferred.

    • EXPERIENCE REQUIREMENTS

  • 1–2 years of experience in insurance verification, healthcare registration, or medical billing.
  • Familiarity with commercial insurance, Medicare, Medicaid, and HMO plans.
  • Experience working with electronic health records and payer websites / portals.

    • REQUIRED TRAVEL

  • N / A

    • PHYSICAL DEMANDS

    Carrying Weight Frequency

    1-25 lbs. Frequent from 34% to 66%

    26-50 lbs. Occasionally from 2% to 33%

    Pushing / Pulling Frequency

    1-25 lbs. Seldom, up to 2%

    100 + lbs. Seldom, up to 2%

    Lifting - Height, Weight Frequency

    Floor to Chest, 1 -25 lbs. Occasional : from 2% to 33%

    Floor to Chest, 26-50 lbs. Seldom : up to 2%

    Floor to Waist, 1-25 lbs. Occasional : from 2% to 33%

    Floor to Waist, 26-50 lbs. Seldom : up to 2%

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    Eligibility Specialist • Fort Lauderdale, FL, US

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