As an Eligibility Representative, the individual will perform a detailed in-house review, and determine if the patients are viable candidates for the state, county, medical, federal, or disability assistance or not. The job description includes performing necessary investigative, administrative, and fieldwork and also assist patients in meeting the eligibility requirements as needed. The job duties listed on the Eligibility Representative Resume include – screening patients to determine potential eligibility; explaining patients the eligibility requirements, and application processes; facilitating the application processes when appropriate; documenting pertinent information; monitoring patient accounts; and maintaining confidentiality pertaining to the health records of patients.
While hiring for this role, employers look for the following skills and abilities – knowledge of maintaining the confidentiality of patient account; good understanding of contents of the employee handbook; knowledge of medical assistance application process; and skillful in reading documents. Eligible candidates are expected to have a college degree in the field of healthcare administration or the related.
Objective : Dedicated Eligibility Representative with two years of experience in health insurance and eligibility verification. Proven ability to navigate complex enrollment processes and provide exceptional support to members. Committed to ensuring accurate eligibility determinations and enhancing customer satisfaction through effective communication and problem-solving.
Skills : Record Management, Attention To Detail, Time Management, Eligibility Assessment
Description :
Responsible for adding, terminating, and reinstating members to health insurance policies.
Adjudicates enrollment applications and resolves issues according to policies and procedures.
Investigates and adjudicates pended documents for enrollment, working closely with underwriting.
Resolves complex enrollment issues with employer groups and brokers effectively.
Assisted clients in determining eligibility for various health programs and services.
Maintains accurate eligibility records and processes all enrollment transactions efficiently.
Collaborates with other departments to address eligibility concerns raised by members.
Experience
0-2 Years
Level
Entry Level
Education
A.S. Health Admin.
Senior Eligibility Representative Resume
Headline : Accomplished Senior Eligibility Representative with 7 years of experience in navigating complex eligibility processes within healthcare systems. Expert in verifying eligibility, managing client accounts, and enhancing customer satisfaction through effective communication. Proven track record in optimizing workflows to ensure accurate determinations and compliance with regulations.
Evaluated immigrant children's documentation for eligibility in government aid programs, ensuring compliance with regulations.
Updated and maintained immigration status information in client accounts for accurate record-keeping.
Communicated with parents to request necessary documentation and provide timely feedback on eligibility status.
Conducted audits of third-party administrators to ensure adherence to immigration procedures.
Assisted in verifying accuracy of translations from English to Spanish for eligibility documentation.
Participated in special projects aimed at improving operational efficiency.
Responded to inquiries from parents regarding their children's eligibility status and provided support for resolution of concerns.
Experience
5-7 Years
Level
Senior
Education
B.S. in HA
Eligibility Representative Resume
Objective : Enthusiastic Eligibility Representative with two years of expertise in healthcare eligibility and insurance verification. Skilled in streamlining enrollment processes and providing superior support to clients. Passionate about delivering precise eligibility assessments while fostering positive member relationships through clear communication and effective problem resolution.
Skills : Microsoft Office Suite, Communication Skills, Resource Management, Compliance Knowledge, Database Management, Telephone Etiquette
Description :
Verified patient insurance eligibility through various online platforms.
Communicated with insurance companies, healthcare facilities, and patients to clarify eligibility issues.
Updated and maintained accurate insurance information in the system.
Processed transactions and managed balance transfers efficiently.
Entered and corrected insurance codes based on contract guidelines.
Submitted claims to payers and handled denial codes for resubmission.
Reviewed EOBs to confirm patient billing details and identify denial reasons.
Experience
0-2 Years
Level
Junior
Education
A.S. Health Admin.
Eligibility Representative Specialist Resume
Objective : Proficient Eligibility Representative Specialist with 5 years of experience in health insurance eligibility and customer support. Adept at analyzing complex client needs and providing tailored solutions. Focused on ensuring compliance and accuracy in eligibility determinations while enhancing member satisfaction through effective communication.
Skills : Data Analysis Software, Team Collaboration, Interpersonal Communication, Workflow Management, Case Management, Research Skills
Description :
Screened uninsured patients and guided them through federal and state charity programs to meet financial obligations.
Prepared detailed reports on eligibility and employee performance, enhancing workflow efficiency.
Facilitated team meetings to discuss client needs and improve service delivery.
Managed billing and collections for hospitals, reducing aged receivables significantly.
Trained new associates on hospital systems and eligibility processes, improving team competency.
Assisted over 100 uninsured patients monthly with financial assistance applications, improving access to healthcare.
Led accounts receivable collections for Duke University, managing over 150,000 accounts valued at $100 million.
Experience
2-5 Years
Level
Entry Level
Education
B.S. in HA
Eligibility Representative Resume
Objective : Seasoned Eligibility Representative with 5 years of experience in healthcare eligibility verification and customer support. Expertise in navigating complex enrollment processes and ensuring accurate eligibility determinations. Dedicated to fostering positive relationships with clients through effective communication and problem-solving, resulting in enhanced customer satisfaction.
Skills : Client Eligibility Support, Quality Assurance, Data Presentation, Financial Verification, Problem Solving, Documentation Management
Description :
Conducted 250-400 individual, family, and couples interview sessions monthly to assess eligibility for services.
Managed all case management and parent education activities to optimize service delivery.
Interviewed clients to determine necessary services and provided tailored recommendations.
Advised clients on community resources, making referrals and developing actionable treatment plans.
Delivered comprehensive case management services to assess client needs accurately.
Collaborated with public social and welfare agencies to gather and share essential information.
Facilitated 10-12 group sessions weekly, focusing on eligibility and benefits education.
Experience
2-5 Years
Level
Consultant
Education
B.S. Health Admin.
Eligibility Representative Assistant Resume
Objective : Result-oriented Eligibility Representative with two years of experience in health insurance eligibility and verification. Demonstrated expertise in managing enrollment processes and ensuring compliance with regulatory standards. Adept at providing exceptional support to clients, enhancing their experience through effective communication and problem resolution.
Skills : Regulatory Compliance, Resourcefulness, Client Education, Time Tracking
Description :
Processed applications and verified client information for accuracy.
Maintained accurate eligibility records for the assigned line of business, ensuring compliance with regulations.
Utilized databases to track client eligibility status and program participation.
Responded to client inquiries regarding eligibility and program details.
Reconciled group eligibility reports with monthly statements to confirm accuracy.
Responded to written and telephone inquiries regarding eligibility from individuals and employer groups.
Researched subscriber information to resolve eligibility problems and disputes.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Eligibility Representative Resume
Objective : Results-oriented Eligibility Representative with two years of specialized experience in health insurance eligibility verification. Demonstrates expertise in managing enrollment processes and delivering exceptional support to clients. Focused on ensuring accurate eligibility assessments while enhancing member satisfaction through effective communication and problem-solving.
Skills : Data Management, Record Keeping, Client Advocacy, Policy Knowledge, Interpersonal Skills, Conflict Resolution
Description :
Guided patients through application processes for various eligibility programs, ensuring timely submissions.
Coordinated appointment scheduling with appropriate agencies to facilitate patient access to services.
Followed up proactively with agencies to verify the status of applications, ensuring timely processing.
Assisted clients in appealing denied applications, advocating for their eligibility rights.
Acted as a liaison between patients and agencies, fostering clear communication throughout the application journey.
Conducted regular follow-ups on accounts in specified inventory to ensure compliance and accuracy.
Maintained accurate records of patient interactions and updated systems with current activity.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Eligibility Representative Team Lead Resume
Summary : Results-focused Eligibility Representative Team Lead with a decade of experience in overseeing eligibility verification processes and team management. Adept at optimizing workflows, ensuring compliance, and enhancing client satisfaction through strategic communication and support. Proven leader committed to fostering a collaborative environment while driving operational excellence.
Managed a team of eligibility representatives, ensuring high performance and adherence to standards.
Facilitated training sessions to enhance team skills in eligibility verification and customer support.
Oversaw the accuracy of patient data entry and eligibility determinations, maintaining compliance with healthcare regulations.
Collaborated with cross-functional teams to improve patient onboarding processes and streamline workflows.
Analyzed eligibility trends and developed strategies to optimize processes and reduce errors.
Monitored and assessed team performance metrics to identify areas for improvement.
Provided exceptional support to clients, resolving complex eligibility inquiries and enhancing satisfaction.
Experience
7-10 Years
Level
Management
Education
B.S. Health Admin.
Eligibility Representative Resume
Objective : Dynamic Eligibility Representative with two years of specialized experience in health insurance eligibility and verification. Skilled in efficiently managing enrollment processes and addressing client inquiries. Passionate about delivering accurate eligibility assessments and fostering positive member relationships through effective communication and problem-solving strategies.
Skills : Client Relationship Management, Proficient In Data Entry And Management, Regulatory Knowledge, Confidentiality, Critical Thinking, Multi-tasking
Description :
Managed discrepancy reports related to employee eligibility for multiple employer groups.
Maintained organized records on spreadsheets and files while meeting internal deadlines.
Resolved eligibility inquiries via email and telephone promptly.
Utilized office equipment effectively, including scanner, fax, and copy machines.
Uploaded electronic data with meticulous attention to detail.
Managed the department's email inbox, delegating inquiries to the appropriate Eligibility Representative.
Ensured employee records were accurate and up to date.
Experience
0-2 Years
Level
Entry Level
Education
A.S. in Health Admin.
Eligibility Representative Resume
Headline : Experienced Eligibility Representative with 7 years in healthcare eligibility verification and enrollment processes. Skilled in assessing complex client needs, ensuring compliance, and improving operational efficiencies. Committed to delivering accurate eligibility determinations and enhancing client satisfaction through effective communication and problem-solving strategies.
Skills : Documentation Skills, Process Improvement, Phone Etiquette, Training Skills, Customer Advocacy
Description :
Maintained accountability for eligibility information, ensuring accurate recording and compliance with regulations.
Coordinated meetings and training sessions to enhance team knowledge on eligibility processes.
Provided access to necessary resources for clients, ensuring smooth enrollment experiences.
Collaborated with security teams to maintain compliance and data integrity.
Established emergency plans to address potential workflow disruptions.
Communicated effectively with members and providers, ensuring timely follow-up on inquiries.
Utilized data analysis to identify trends and improve eligibility processes.
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