Patient Records & Eligibility Specialist

Patient Records & Eligibility Specialist

Upward Health is a home-based medical group specializing in primary medical and behavioral care for individuals with complex needs. We serve patients throughout their communities, and we diagnose, treat, and prescribe anywhere our patients call home. We reduce barriers to care such as lengthy delays due to scheduling. We see patients when they need us, for as much time as they need, bringing care to them. Beyond medical supports, we also assist our patients with challenges that may affect their health, such as food insecurity, social isolation, housing needs, transportation and more. It is no wonder 98% of patients report being fully satisfied with Upward Health!

Upward Health provides technology-enabled, integrated, and coordinated care delivery services that improve outcomes and reduce costs for patients with severe behavioral health diagnoses and co-morbid, chronic physical conditions. We are not your typical medical practice. At Upward Health, we see every day as an opportunity to make a difference in our patients' lives. We could tell you about our outcomes and patient satisfaction ratings. We could tell you about our commitment to our mission. Or you could join us and experience it all for yourself.

Why Is This Role Critical?

Patient Records & Eligibility Specialists serve in a variety of healthcare systems handling patients’ medical records and ensuring their information is transferred, stored, and shared properly. They’re responsible for collecting patients’ information, such as medical history and demographics for use in audits, requests for medical records, and other such release of information requests. Patient Records & Eligibility Specialists must have advanced understanding of healthcare company policies and procedures to properly keep accurate records.

They must also review payer portals to ensure proper eligibility on a regular basis. The Patient Records & Eligibility Specialists must understand how to navigate and understand eligibility information and ensure any missing eligibility information is gathered and documented. Additionally, this role will assist in resolving any discrepancies or issues related to eligibility or authorization.

KEY RESPONSIBILITIES

• Inbound fax triage and uploading documents to patient’s charts as applicable
• Verifying patient’s insurance eligibility through payer portals
• Responding to medical record audit requests either by patients, caregivers, payers, auditors, and other such external stakeholders and doing so through deep understanding of and compliance with Upward Health’s policies and procedures for medical record sharing
• Creating digital copies of paperwork and storing the records electronically as needed

KNOWLEDGE, SKILLS & ABILITIES

• Knowledge of HIPAA medical privacy regulations and practices
• Excellent verbal and written communication skills
• Advanced organization skills
• Attention to detail to ensure accuracy of work output
• Strong data entry skills
• Excellent problem-solving skills
• Understanding of medical terminology
• Basic computer skills to scan, organize, and access electronic health records

MINIMUM REQUIREMENTS

• High school graduate or GED
• 1-2 years prior experience in a medical office, practice, hospital, or outpatient healthcare facility
• Prior experience in health information/medical records department
• Able to maintain clear professional boundaries with coworkers

PREFERRED REQUIREMENTS

• Prior experience in health insurance is preferred
• Associate degree or a similarly accredited program in health information technology or healthcare
• Course work experience in anatomy, data systems, physiology, coding systems and health care reimbursement
• Certified Registered Health Information Technician (RHIT) or the Certified Electronic Health Records Specialist (CEHRS)

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. All individuals selected for a position will undergo a background check appropriate for the position's responsibilities.

**We require all our employees to be vaccinated and to show proof of vaccination upon hire**