Medical Eligibility Specialist – North Fresno
A medical practice in North Fresno is seeking a Medical Eligibility Specialist to join their team. This role is responsible for determining patient insurance eligibility, gathering necessary information through interactive interviewing, and ensuring accurate data entry to support smooth patient registration, billing, and reimbursement workflows.
Position Details
• Full-Time, Monday–Friday
• 8:00am–5:00pm
• $25-27.00 per hour
• Location: Fresno, CA
About the Role
The Medical Eligibility Specialist verifies insurance eligibility, benefits, and authorizations for patients. This position requires strong attention to detail, clear communication, and the ability to manage a fast-paced caseload. Experience with Clearwave for patient check-in and Intergy (Greenway Health) for practice management is highly preferred.
Key Responsibilities
• Verify insurance eligibility and benefits prior to appointments using Clearwave and payer portals
• Accurately enter and update patient demographic, insurance, and authorization details in Intergy
• Identify and resolve eligibility discrepancies to prevent delays or claim denials
• Communicate with patients about coverage issues, referrals, and cost responsibilities
• Coordinate with scheduling, billing, and clinical teams to ensure seamless information flow
• Maintain HIPAA compliance and patient confidentiality
• Monitor daily eligibility queues and follow up on pending verifications
• Assist with prior authorizations as needed
• Generate eligibility and insurance reports for internal review
Qualifications
• Minimum 2 years of experience in medical eligibility or a healthcare front-office role
• Proficiency in Clearwave and familiarity with Intergy or similar EHR/PM systems
• Strong understanding of commercial insurance, Medicare, and Medicaid
• Excellent attention to detail, accuracy, and problem-solving
• Strong communication and interpersonal skills
• Ability to prioritize and multitask in a high-volume medical environment
Preferred Skills
• Experience working with referrals and prior authorizations
• Basic understanding of medical billing and coding
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