Eligibility Specialist Resume Samples - Page 2

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Eligibility Specialists determine whether or not applicants meet the necessary qualifications for various programs. Example resumes for this position indicate skills like gathering information related to applications for public assistance programs, reviewing submitted applications, identifying the required client data and verification that must be collected for eligibility determination, and reviewing case information and preparing it for disposition. Education requirements vary for this position, but sample resumes show that good communication and computer skills are essential, as is a high school diploma.

11

Eligibility Specialist

The Eligibility Advisor is responsible for verifying, documenting and coordinating information needed to process beneficiaries through health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry and validation for timely processing.

  • Provides enrollment assistance and HIPP program information over the phone to beneficiaries
  • Verifies, documents and investigates presence of health care coverage for Medicaid recipients and their families.
  • Assists in the identification of beneficiaries that might qualify to have enrollment packages issued in relation to this project
Candidate Info
6
years in
workforce
9
months
at this job
Computer Networking
12

Eligibility Specialist

The Eligibility Advisor is responsible for verifying, documenting and coordinating information needed to process beneficiaries through health insurance policy analysis, documentation verification, employer coordination and customer service while ensuring accurate data entry and validation for timely processing.

  • Provides enrollment assistance and HIPP program information over the phone to beneficiaries
  • Verifies, documents and investigates presence of health care coverage for Medicaid recipients and their families.
  • Assists in the identification of beneficiaries that might qualify to have enrollment packages issued in relation to this project
Candidate Info
4
years in
workforce
1
year
at this job
13

Customer Care Rep/eligibility Specialist

  • Responsible for answering inbound customer, payer, and attorney calls related to patient accounting questions for hospitals. Calls are primarily related to accounts with government and non-government insurance however may also be for self-pay and uninsured.
  • Handling COB, EOB refunds, and law offices
  • Answer the calls timely without drops/abandons.
  • Ascertain the reason for the call and assist the caller with their questions, concerns or problems with the focus on first call resolution.
  • Verifying different types of insurance and billing
  • Requesting itemized billing and UB04
Candidate Info
8
years in
workforce
4
months
at this job
AS
Arts
14

Eligibility Specialist

Assess senior clients' eligibility for the State's ride free transit program.

  • Upload required documents to client's computerized file.
  • Follow-up for client's eligibility certificate for them to receive their ride free
  • Resolve client issues and concerns if not eligible for the program at this time.
  • Refer clients to other resources they need or want to participate in.
Candidate Info
4
years in
workforce
1
year
at this job
HS
High School Diploma
15

Quality Control Eligibility Specialist

Establish customer service skills in every call handled.

  • Extensive research skills were needed to provided client with accurate information pertaining to case using Tiers and case comments
  • Provide weekly coaching's to agents regarding their call handling
  • Met weekly goals to complete 30 or more calls graded per team
  • Provide agents with guidance and assistance on how to perform their daily duties as CCR's
Candidate Info
9
years in
workforce
2
years
at this job
HS
High School Diploma
BA
Communication Studies
16

Eligibility Specialist

Gathering detailed personal and income based information related to applications for public assistance programs under the Family and Social Services Administrations (FSSA).

  • Providing accurate and complete information to state eligibility consultant who will make the eligibility decision for various public assistance programs.
  • Reviewing applications submitted, identifying missing required client data and verifications that must be collected in support of the eligibility determination.
  • Initiating calls to and responding to calls from clients in the data collection process.
  • Reviewing case information and preparing it for case disposition by the state eligibility consultant.
  • Explaining forms and program guidelines and answering questions regarding programs to clients.
  • Entering data into a navigating through multiple database applications.
  • Accurately and efficiently completing tasks with high quality and timeliness.
  • Working independently of immediate and continuous supervision.
  • Performing related duties as assigned.
Candidate Info
5
years in
workforce
1
year
at this job
AS
Information Technology
Nursing Aid
17

Eligibility Specialist

  • Responsible for gathering information related to applications for public assistance programs.
  • Reviewing applications submitted.
  • Identifying required client data.
  • Verifying data in support of the public assistance eligibility determination.
  • Communicating with clients.
  • Reviewing case information and preparing it for case disposition by the state eligibility consultant.
Candidate Info
17
years in
workforce
1
year
at this job
18

Eligibility Specialist

  • Verify eligibility status, co-pay, and re-certification with Medicaid/Medicare clients.
  • Assigned new PCP's for clients.
  • Confirm benefits and authorizations for Primary Care/Mental Health.
  • Perform annual and quarterly assessments for all PC enrolled patients for Amida Care members.
  • Review and update self pay and denial reports.
  • Help develop [company name]'s Medical Internship Program.
Candidate Info
7
years in
workforce
3
years
at this job
BS
Marketing
BS
Marketing
19

Eligibility Specialist

  • Responsible for gathering information related to applications for public assistance programs.
  • Provide information to state eligibility consultant who make the eligibility decision for various public assistance programs including TANF, food Stamps and Medicaid.
  • Review applications submitted, identifying required client data and verifications that must be collected in support of the eligibility determination.
  • Communicate with clients in the data collection process, reviewing the case information and preparing it for case disposition by the state eligibility consultant.
  • Specialization in Nursing Home and Medicaid Disability cases
  • Utilization of computer programs ICES and WFMS
Candidate Info
10
years in
workforce
3
years
at this job
CNA
Certified Nurse Assistant
20

Eligibility Specialist

  • Collect and review patient information to determine patient's eligibility for Medicaid and charity programs.
  • Completion of both on line and paper Medicaid / Disability application.
  • Research discrepencies of insurance / registration, as well as benefits verification.
  • Serve as direct liason among case management and eligibility.
  • Assist the uninsured population with their Market Place application during open enrollment.
Candidate Info
9
years in
workforce
2
years
at this job

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