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Eligibility and Enrollment Specialist

Medical Insurance Enroller | The Woodlands, TX | Contract

Job Description
Eligibility and Enrollment Specialist
Work Location: The Woodlands, TX

Job Summary/Description
The Coordinator conducts and assists in all aspects of both determining eligibility and enrolling patients into programs by executing the following duties: Reviewing and understanding the contractual requirements that determine eligibility for this program, navigating through medical records and practice management systems in addition to internal Innovent IT systems, and utilizing understanding of Oncology terminology and critical thinking to gather data to summarize the treatment plan for each patient to complete enrollment. Additional job functions include: Providing completed work each day to the payer, answering questions from the payer about enrolled patients and marking outcomes of eligibility into the Innovent IT system. Understanding the basic rules for Billing the episodes in order to communicate well with the Practice billing department. Maintaining various reports / spreadsheets, supports and adheres to the McKesson Compliance Program, to include the Code of Ethics and Business Standards as well as all HIPAA protocols and client contractual obligations.

Job Duties/Responsibilities/Functions (including but not limited to)
• Assists in all aspects of determining patient eligibility for Innovent programs:
o Follows specific contract requirements—must understand details of contracts
o Navigate through multiple IT systems
o Review of Electronic Medical Records for active treatments and plan of care
o Understanding of Oncology Chemotherapy treatments (IV/Oral /Hormonal) *Verification of insurance benefits
o Responsible for understanding basic billing rules for episodes
o Understanding of different Payment Conditions
• Communication with Provider and Payers:
o Answer questions from Payer about eligibility and Payment conditions
o Discuss with Provider basic rules for billing of episodes
o Work with Analytics team regarding gathered data
• Assist in all aspects of enrolling eligible patients into Innovent Programs:
o Document in Innovent IT systems
o Populate all required information into the Payer Spreadsheets *Outreach to provider to obtain missing clinical data
o Populate all data on Master Spreadsheet 35%
• Assist with reviewing patients as needed for payer and provider audits of enrolled patients.
• Performs other duties as assigned.

Minimum Qualifications
• High school diploma or equivalent
• Must have knowledge of Medical Terminology
• Must have Advanced Microsoft Word, Outlook experience
• Must be an Analytical Thinker and Problem Solver –Extremely important
o Self-Motivator – works efficiently without daily direction
o Highly Organized
o Multitasker who can prioritize job duties
o Excellent Telephone Skills
• Additional Knowledge/Skills: (preferred)
o Oncology terminology
o Understanding of Adjuvant and Metastatic patients
o Understanding of IV Chemotherapy treatments /Hormonal only treatments / Palliative Care
o Understanding of reading a Pathology /CT /PET etc. reports and determining the outcome


About InGenesis
InGenesis is dedicated to placing people in positions that preserve life, improve lives and inspire others. This does not happen without passionate people, skilled colleagues who are motivated to create innovative solutions and deliver superior service to our clients. Founded in 1998, InGenesis manages thousands of employees, including pioneering healthcare, science, technology and pharma professionals. The workforce solutions company includes almost half of the Fortune 500 in its nearly 300 clients. It is recognized as one of the largest healthcare staffing firms, and InGenesis is the largest minority/women owned healthcare staffing firm in North America.

EEOC Statement
We support a diverse workforce and is an Equal Opportunity Employer who does not discriminate against employees and applicants for employment on the basis of race, gender, color, religion, national origin, age, sexual orientation, gender identity, genetic information, disability, veteran status, or other classification protected by law.