Benefit Eligibility Specialist

Responsibilities

• Medical Records Management: Request, track, and review medical records from facilities and providers to support client benefit eligibility determinations.
• Maintain a thorough understanding of HIPAA requirements as they apply to the handling, storage, transmission, and disclosure of protected health information (PHI).
• Fax & Document Management: Send, receive, and track faxes to and from medical facilities, authorized representatives, and other stakeholders.
• 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.
• 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.
• 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.
• Manage multiple open records requests and client cases simultaneously, maintaining a high level of accuracy and organization throughout all stages of the process.
• Commit to outstanding customer service, striving for continuous improvement in client satisfaction.
• Effectively explain processes and benefits to clients, their authorized representatives, and other stakeholders in a clear and professional manner.
• Schedule and manage follow-up calls and tasks tailored to individual client and facility needs to ensure timely resolution.
• Offer virtual support and guidance during client assistance events.
• Represent the company with professionalism, always prioritizing client needs and ensuring they find the support they seek.

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.