Benefit Eligibility Specialist
Overview
COMPANY:
We are people who care about people. Our company has a unique history and was founded by two grandchildren of a former Department of Energy worker. Their love and determination for their grandfather to have the best quality care for the best quality of life is what drives our company to provide care for the energy worker population.
POSITION SUMMARY:
The Benefit Eligibility Specialist serves as the primary liaison for clients navigating the intricacies of the Energy Employees Occupational Illness Compensation Program Act (EEOICPA) and the Radiation Exposure Compensation Act (RECA) programs. This role is central to requesting, tracking, and reviewing medical records in full compliance with HIPAA regulations, while maintaining consistent communication with medical facilities and clients. With a focus on detail, accuracy, and compassionate service, this entry-level role in the Growth Department provides unparalleled client assistance, fosters collaboration across teams, and ensures effective communication both internally and externally.
Responsibilities
- Medical Records Management: Request, track, and review medical records from facilities and providers to support client benefit eligibility determinations. Ensure all records requests and handling are conducted in strict accordance with HIPAA privacy and security regulations.
- HIPAA Compliance: Maintain a thorough understanding of HIPAA requirements as they apply to the handling, storage, transmission, and disclosure of protected health information (PHI). Ensure all client interactions and documentation adhere to applicable privacy standards.
- Fax & Document Management: Send, receive, and track faxes to and from medical facilities, authorized representatives, and other stakeholders. Maintain organized and accurate records of all outbound and inbound communications.
- Facility & Client Outreach: Conduct outbound calls to medical facilities to follow up on records requests, verify information, and resolve outstanding items. Communicate with clients and their authorized representatives to provide status updates and gather necessary information.
- Guidance and Liaison Role: Act as the primary point of guidance for clients concerning their medical-card benefits, ensuring they understand the nuances of the EEOICPA/RECA programs.
- Data Management & CRM: Ensure accurate data entry and maintain trackable records in HubSpot and other systems. Log all client interactions, records requests, and follow-up activity with precision and consistency.
- Relationship Building: Develop and foster strong relationships with clients, their authorized representatives, case managers, medical facility contacts, and internal teams to facilitate seamless communication and problem-solving.
- Detail Orientation & Organization: Manage multiple open records requests and client cases simultaneously, maintaining a high level of accuracy and organization throughout all stages of the process.
- Customer Service Excellence: Commit to outstanding customer service, striving for continuous improvement in client satisfaction.
- Clear Communication: Effectively explain processes and benefits to clients, their authorized representatives, and other stakeholders in a clear and professional manner.
- Follow-Up Management: Schedule and manage follow-up calls and tasks tailored to individual client and facility needs to ensure timely resolution.
- Event Support: Offer virtual support and guidance during client assistance events.
- Professional Representation: Represent the company with professionalism, always prioritizing client needs and ensuring they find the support they seek.
Perform other duties as assigned.
OTHER DUTIES AND RESPONSIBILITIES:
This position may require traveling between locations in your personal vehicle.
SUPERVISORY RESPONSIBILITY:
This position has no supervisory responsibilities
Qualifications
PREFERRED QUALIFICATIONS:
- Familiarity with the EEOICPA/RECA programs or a willingness to undergo training is highly beneficial.
- Prior experience in medical records requests, healthcare administration, or a related field is strongly preferred.
- Working knowledge of HIPAA regulations and the handling of protected health information (PHI).
- Experience with HubSpot CRM or similar CRM platforms is a plus.
- Prior customer service experience is essential, with a preference for candidates experienced in telephone communication with medical facilities or healthcare providers.
- Exceptional attention to detail and strong organizational skills, with the ability to manage multiple tasks and prioritize effectively.
- Exceptional communication and interpersonal abilities, apt for liaison roles involving facilities, clients, and internal teams.
- Proficient in Microsoft Suite, fax systems, and CRM platforms.
- Commitment to maintaining client confidentiality and privacy at all times