As an Eligibility Analyst, the professional will be accountable for applying all contract provisions and procedures ensuring accuracy and timeliness of all eligibility changes. The job duties associated with the role are listed on the Eligibility Analyst Resume as – providing consistent service to customers on processing eligibility related changes, evaluating eligibility and planning level changes received, researching, analyzing and solving routine and non-standard eligibility requests and escalated issues; explaining and educating contract provisions, and billing procedures, handling inquiries for research and explanation; assessing eligibility requirements and determining evidence of insurability; participating in team meetings and sharing information and best practices; participating on special projects as assigned, and maintaining consistent accuracy to provide a positive customer experience.
Functional skills include – a thorough understanding of the billing administration process, workflows, and technical requirements; the ability to make independent decisions; strong oral and written communication skills, experienced PC and navigational skills, and strong interpersonal skills. Employers seek applicants with a degree in a relevant field.
Headline : To obtain a job in a professional, friendly environment where I can utilize the skills I have acquired through previous employment and education, as well as grow in new knowledge and experience.
Provided quality service for the implementations and ongoing management of eligibility relationships.
Coordinated and participated in meetings with internal and external customers with a strong focus on customer service.
Performed analysis, while making business recommendations to improve the integrity of the eligibility data.
Worked with external partners in preparing eligibility data to ensure the accuracy of client and patient information.
Recommended changes or corrections to eligibility data or eligibility mapping fields within the Optum database system.
Worked with clients to create and coordinate method of data file transmissions to the IT Eligibility department for file loading.
Ensured group/plan structure determinations are entered accurately and timely so that benefits and enrollment can be loaded properly.
Experience
5-7 Years
Level
Executive
Education
GED
Eligibility Analyst Resume
Summary : A self-motivated and organized professional with over 20 years' experience in the financial and insurance industry. Possesses a broad range of knowledge and skills with a strong background in accounting, wealth management and estate planning. Client-service focused and excellent ability to support management in the day-to-day processes.
Skills : FTP, PGP & SFTP Quick Books, Data Entry, 10 Key, Accounting Calculator, Fax, Filing, Phone , Organizational and Detail Oriented, as well as self-motivated.
Description :
Analyzed, updated, maintained and corrected CIGNA relational databases for accounts such as UPS, CitiGroup, Costco and others and served as their first point of contact, researching and solving their problems and maintaining client satisfaction Liaised between CIGNA and Anne Arundel County, Maryland in incorporating Vision benefits into the employee health benefit package.
Developed and implemented new procedures for 3 employee divisions resulting in a smooth benefit supplement.
Created and implemented internal audits to validate CitiGroup employee benefits, utilizing SQL programs by category in a relational database.
Reduced discrepancies between CIGNA and CitiGroup coverage databases by over 95%.
Created simple SLQ scripts and modified complex SQL data as needed to perform required task.
Problem-solved client coverage denials by matching coverage with eligibility and serving as a single-point-of-contact between the client and internal departments.
Solved problems in a single phone call 87% of the time.
Experience
10+ Years
Level
Senior
Education
Master Of Business Administration
Eligibility Analyst Resume
Headline : Self-motivated professional with experience in customer service and process administration seeking a position that will allow me to exemplify professionalism, ability to execute multiple projects and tasks, demonstrate history of successful client interaction, and project management while facilitating innovative and efficient solutions to client issues.
Skills : MS office, Analyst.
Description :
Handled of enrollment forms according to the contact provisions of the assigned accounts.
Determined individual s effective date, Plan, PPO.
Determined and entered eligibility into multiple systems, including pharmacy vendor systems and the Delta Dental system.
Notified individual of the pre-existing provision of the plan and their right to submit creditable coverage and send General COBRA letter Handling of customer service calls for clients and members.
Notifiied ancillary vendors of changes in eligibility.
Prepared and distributed Eligibility Reports, Census and Special Reports for the clients on a monthly basis, as well as upon request.
Audited for accuracy.
Experience
5-7 Years
Level
Executive
Education
Business Communication
Eligibility Analyst Resume
Summary : Participating in full life cycle development by performing requirements analysis, process development and design, and testing using development methodology. Collaborates with functional teams, as well as with IT business analysts and programmers to develop detailed design specifications according to standards.
Processed returned Eligibility mail, troubleshooting coverage issues with outside vendors, and assisting the claims department with eligibility issues that occur during claims processing.
Improved and streamlined data integrity, reduced errors and increased client satisfaction by conducting in-depth technical walkthrough with ADP (third party vendor) to identify processing methods.
Streamlined Anne Arundel County's electronic submission to CIGNA.
Provided quality assurance checks to ensure all fields are complete and able to be processed.
Attended implementation meetings with clients and staff to discuss eligibility requirements and protocols.
Provide timely updated eligibility information (new hires, terminations, reinstatements, schedule changes, deaths, and student verifications) to various outside vendors such as Cigna, Highmark, UPMC, Aetna, Delta Dental, CVS Caremark, Etc.
Maintained accurate/efficient participant and dependent eligibility in accordance with written plan procedures.
Experience
10+ Years
Level
Senior
Education
Business Communication
Eligibility Analyst Resume
Summary : Over 7 years' experience in Eligibility Analyst with extensive experience in data entry. Skilled in insurance benefits and knowledge in medical terminology. Proficient in governmental assistant programs.
Skills : Microsoft Office, Citrix, Medical Terminology, As400, Passport.
Description :
Assisted patient with completing government program application and secure documents needed for eligibility determination.
Reviewed and analyzed patient financial information to determine eligibility for governmental programs.
Maintained professional and courteous working relationship with government and client staff.
Maintained daily log and work queue as needed.
Reported all findings and status with case management in a timely and professional manner.
Propered noting and documenting on hospital system and RAMS.
Experienced knowing that I was able to help patient's.
Experience
7-10 Years
Level
Management
Education
MS
Eligibility Analyst Resume
Headline : Results-driven Eligibility Analyst with expertise in multiple functions that provide employee benefits and service the health care sector. A leader for over twenty years with proven ability to successfully manage a variety of functions through motivation, strategic analytical skills, cohesive team building, strong data management capabilities and ability to solve difficult business problems.
Skills : Microsoft Office Suite, People Soft HR, ADP HR, HRMS,.
Description :
Onsite eligibility screenings for inpatient and outpatient accounts, responsible for completing financial statements, charity applications, Medicaid and SSI/SSD appliations at the patient's bedside.
Conducted DCF face to face interviews for patients.
Assisted with getting bills to dcf for bill tracking on share of cost cases.
Organized referrals to be given to the appropriate analyst after final bill.
Prepared Medicaid approvals and closings together to give to hospital billers.
Checked medifax system on weekly basis for Medicaid approvals.
Ability to work well with corporate level of client staff down to clerical staff with confidence.
Experience
5-7 Years
Level
Executive
Education
MS
Eligibility Analyst Resume
Headline : Eligibility Analyst focused on developing efficient processes using knowledge of recruiting, employee relations, training and development and auditing.
Skills : Outlook, Microsoft Office, Recruiting, Training, Customer Service, Sales, Human Resources, Benefits Administration.
Description :
Interviewed and prescreened patients bedside to determine third party insurance.
Assisted patients in completion of government program applications and obtaining verification documents required for eligibility determination.
Maintained professional and courteous working relationships with physicians, patients, hospital, and government staff.
Performed field visits to client homes when needed to assist in medical application process.
Maintained daily log and work queue, conduct weekly follow up, note, and document all information in timely manner.
Reviewed all self-pay and government pending status.
Reported all findings and status updates.
Experience
5-7 Years
Level
Executive
Education
Master Of Science
Eligibility Analyst Resume
Headline : As an Eligibility Analyst, responsible for working closely with internal teams and 3rd party partners on owning and improving existing integrations and implementing new integrations (gathering and defining requirements, coordinating file build, testing, go-live, etc).
Skills : Coordinating Skills, Analyst.
Description :
Represented patients and their families before government officials in fair hearings.
Redetermined eligibility based off monthly reports and any late work reported.
Processed of disability credits.
Prepared and mailed initial eligibility letters, reinstatement letters, termination letters, HIPPA notices, quarterly/yearly work history statements and Cobra notices.
Prepared pension statements and pension summaries by request per participant.
Defined pension benefits per fund rules.
Confirmed that clients met the criteria to be eligible for funding in which they applied Reached out to clients in the final stages of processing.
Trained coworkers and how to review closing documents to finalize their customer's claims.
Assured the accurate, prompt determination and re-determination of applicant eligibility for enrollment in TBHP's Unicare and Child Health Plus.
Experience
5-7 Years
Level
Executive
Education
Master Of Science
Eligibility Analyst Resume
Headline : Seeking a company where I can grow professionally and personally and use my customer service and photography experience to help your company meet and surpass its goals.
Responsible for the monthly load, analysis, review, and processing of approximately 30 EDI files for senior and commercial plans for 4 IPAs and medical groups utilizing Eligibility Manager.
Identified and manually corrected critical discrepancies and issues within the load which could disrupt the overall EDI process.
Consistently provided quality customer service to clients by answering a number of questions based on eligibility, copays, dual coverage, and COB utilizing Access Express.
Produced new benefit mapping and EDI discrepancy reports as required for management review.
Worked monthly issue reports as part of production for terminated members and open pending authorizations.
Communicated with insurance carriers regarding EDI file issues and collaborated with Network Management regarding non-par physician disparity.
Participated in meetings and identified process improvements to increase overall effectiveness and quality during open enrollment periods.
Experience
5-7 Years
Level
Executive
Education
AA In Business Administration
Eligibility Analyst Resume
Summary : Responsible for Responding, researching, and resolving eligibility and other enrollment related issues involving member specific information by working directly with clients, vendors, and internal partners to achieve positive service outcomes.
Skills : MS office, Customer Service.
Description :
Determined client eligibility for enrollment in the Coordinated Care Program of the Health Care District.
Responsible for delivery of high-quality customer service with attention to special needs of a diverse client base.
Interviewed persons in need of services and assisted them in navigating the documentation process.
Analyzed application materials in order to make appropriate decisions regarding client eligibility.
Conducted interviews of client in order to compile financial and social history of clients and obtained necessary data for eligibility determination.
Acted as a liaison between applicants and other social services providers.
Performed various administrative support tasks (such as data entry, memos, letter and emails) ensuring efficient work flow.
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