Senior Eligibility Specialist

Job Grade: 4

Are you energized by helping others? Are you a builder who thrives on fast-paced, high-impact work? Are you driven to change the standard of care in women’s health?

The Lactation Network is hiring a Senior Eligibility Specialist. This position is responsible for verifying coverage and coordinating benefits, specifically for our Employer Contracted lactation consultation visits, as well as collecting and entering patient information and managing multiple accounts. The role works on the Lactation Services Billing Team and expedites the intake process for TLN.

We are a small, tight-knit, purpose-driven organization with big growth goals in 2025 and beyond. We don’t have all the answers and we don’t expect you to, either. We do expect you to be curious, hardworking, and striving to be your best self.

Breakdown

·       Eligibility Insurance Communication (50%). You’ll work closely with our Strategic Partnership and Patient Care teams to ensure a smooth eligibility and intake process for patients participating in our Newborn Families and special project programs.

·       Gathering & Maintaining Information (30%). Daily review of patient account information ensuring accuracy and completeness. Maintain and update current standard operating procedures for newly acquired accounts.

·       Record Handling (20%). Ability to move through database systems quickly and efficiently while maintaining a high attention to detail.

What you’ll do

·       Verification of patient insurance, coordination of benefits and determination of coverage for lactation consultation visits per company policy

·       Reviewing hundreds of patients’ information on a daily basis while maintaining HIPAA standards of confidentiality

·       Familiarity with Insurance payer portals, eligibility verification processes and insurance plan types

·       Occasional after-hours, weekend, and holiday work on a voluntary basis

·       High level of detail and accuracy required for maintaining and updating patient records.

·       Contributes to team effort by not only delivering on defined responsibilities but also supporting other team members in their roles as needed.

·       Willingness and ability to adapt to changing processes as needed.

What we expect from you

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

·       High School Diploma or equivalent required

·       3+ years of healthcare experience

·       Dedicated to providing outstanding customer service.

·       Strong communication skills with an understanding of insurance companies

·       High level of detail-orientation

·       Requires knowledge of billing relationships, insurance providers and plans

·       Ability to multi-task and work in a fast-paced environment without getting distracted.

·       Self-starter with the ability to work collaboratively on a team and to take direction.

·       Excellent telephone and email skills and etiquette

What we’d also love to see

·       Healthcare office experience

·       NextGen & Salesforce experience. 

What you can expect from us

·       Unlimited PTO. We work hard. We’re passionate about what we’re building together. We also have lives outside work.

·       Benefits. Medical plus voluntary vision, dental. (We are a healthcare company, after all.)

·       401(k) with employer match. We’re planning for the future—and we want to help you do the same.

·       Flexibility on remote work. We like spending time together in our West Town office and are transitioning to a flexible in-office culture for those who want to return to work in-person. Some team members will continue to work remotely (based upon role and/or geography).

·       Wellness. You’ll have complimentary access to the leading app for meditations, sleep stories, and other wellness resources.

·       Recharge. We have one designated “no meeting day” each week so you can take a break from videoconferencing and have some quiet time to focus.

·       Professional development. We invest in our team by offering every employee access to a professional development budget.

·       Competitive compensation. We’re looking for top talent.

·       A growth environment. The sky’s the limit.

About Lactation Network

The Lactation Network is setting a new standard for parents and lactation consultants alike. At TLN, our movement goes beyond any single outlet or tool. We activate education, connection, and advocacy to foster the new network of inclusive care between parents and IBCLCs; the network where every caregiver has the resources to thrive. TLN is powered by the largest network of IBCLCs in the country. Together, we are here to make sure families get the expert insurance covered lactation care that they deserve.

The Lactation Network is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.