Eligibility and Risk Specialist

Since 1957, Shield Healthcare has provided high-quality healthcare services while focusing on customer satisfaction and employee achievement. We are dedicated to fulfilling the medical supply needs of consumers and the caregiving community while maintaining a 99% overall customer satisfaction rating. Over the years, Shield HealthCare has expanded nationally with current service locations in California, Colorado, Illinois, Ohio, Texas and Washington.Shield HealthCare is looking for an Eligibility and Risk Specialist in Valencia, CA responsible for verifying eligibility and risk delegation for health plan members and properly maintaining customer records. Research related rejections and denials and make the necessary corrections to meet billing guidelines or recommend claims for write-off.This position is on-site in Valencia, CA.Job ResponsibilitiesResponsible for verifying eligibility and risk delegation for health plan members and properly maintaining the customer records Ensure that all eligibility verification requests are completed in a timely mannerResearch problems and find solutions to eligibility related claim rejections and denialsInform management of changes or trends with eligibility and risk issues Research denials and billing requirements of third-party carriers utilizing web portals, phone contact, EOBs, provider manuals, etc. Adjudicate claims issues by preparing and submitting corrected claims or appealsRecommend claims for write-off when billing requirements are not metEffectively communicate by phone, email, and in-person with third-party payers and internal staff to resolve eligibility issues and establish positive relationshipsAccurately update and notate accounts receivable system, collections notepad, and customer accountsRemain updated on company policies and procedures and third-party payer guidelines, bulletins, and billing requirementsWork reports and projects assigned by managementEnsure appropriate follow-up and timely completion of assignmentsQualificationsFamiliarity with various medical insurance payer guidelines/billing requirements preferredProficiency in Microsoft Office with experience working in Microsoft ExcelMust be detail oriented, thorough, accurate, and organizedProven ability to research and solve problemsGood written and verbal communication skillsPay & BENEFITS$19-20 / hourMedical, Dental, and Vision 401(k) with Company Match Sick and Vacation Days Flexible Spending Account Life & Disability Insurance Education AssistanceEmployee Referral ProgramCareer-minded individuals will find our business challenging and our reputation for excellence just one of the rewards we have to offer. To further enhance this tradition of excellence, our employees participate in continuous training and development programs in a variety of disciplines.