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Eligibility Specialist
Job Description
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
INDHP
Additional Information
Career Expert
Renata Soto
Healthcare Account Manager
Meet Renata, our dedicated Healthcare Account Manager on the Central California team! Renata brings a unique blend of experience and enthusiasm to her role, having previously worked as a Recruiter for two years and in the school system where she gained valuable expertise in HR, Recruiting, and Payroll. Her diverse background has equipped her with a strong understanding of both the administrative and human sides of staffing, making her a well-rounded and effective team member.
One of Renata’s proudest professional accomplishments was streamlining her previous employer’s system—transforming it into a more efficient and effective operation. Her ability to identify areas for improvement and implement meaningful changes speaks to her proactive mindset and commitment to excellence.
At Hire Up, Renata has quickly become a valued part of our team. She thrives in our collaborative environment and appreciates the way everyone works together to achieve shared goals. Her drive to grow professionally is evident in her ambition to take on more responsibilities and eventually step into a leadership role.
Renata’s positive energy, attention to detail, and passion for helping others make her an incredible asset to our Central California team. We’re lucky to have her on board and excited to see all she’ll accomplish in the future!
