Benefits and Eligibility and Account Specialist

Description:

The Orthopaedic Eligibility & Benefits and Patient Account Specialist is responsible for verifying patients’ insurance coverage, determining benefits ensuring accurate financial information prior to orthopaedic procedures or visits and collects payments from patients.

• Verify patient insurance eligibility and benefits (medical, surgical, therapy services)
• Confirm coverage for orthopaedic procedures (e.g., surgeries, imaging, physical therapy)
• Obtain prior authorizations and referrals when required
• Communicate patient financial responsibility (copays, deductibles, coinsurance)
• Provides telephone customer service in a high call volume environment by responding to patient billing questions as well as working payor denials and collections on patient accounts (as needed)
• Interpretation of Explanation of Benefits (EOB); responding to billing questions or requests for information; collecting patient balances
• Coordinate with insurance companies to resolve coverage issues
• Enter and update insurance information in electronic health records (EHR)
• Work closely with AR and clinical teams
• Ensure compliance with HIPAA and payer guidelines
• Document all verifications, authorizations and payments accurately

Job Type

Full-time

Schedule

8:30 AM - 5 PM

Monday to Friday (No weekends!)

Work Location

On site Required: Palm Beach Gardens location

Benefits

• 401(k)
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Requirements:

Skills & Qualifications

• Knowledge of medical insurance plans (PPO, HMO, Medicare, Medicaid)
• Familiarity with orthopaedic procedures and terminology (preferred)
• Knowledge of CPT, ICD-10, and HCPCS coding (basic to intermediate)
• Strong attention to detail and accuracy
• Excellent communication and customer service skills
• Experience with EHR and practice management systems
• Ability to handle high-volume verification tasks

Education & Experience

• High school diploma or equivalent (required)
• Associate degree in healthcare administration (preferred)
• 1–3 years of insurance verification or healthcare front-end experience