Eligibility and Billing Specialist

About the Role

We're looking for a team-oriented and mission-driven Eligibility and Billing Specialist to support families throughout their financial journey by verifying insurance eligibility and benefits while providing exceptional billing support and customer service. You will help ensure patients understand their insurance coverage, financial responsibility, and payment options before and after receiving services. This role reports to the Director of Revenue Cycle Management and partners closely with the Health Plan Operations, Care Coordination, and Revenue Cycle teams.

Role type: Full-time (40 hours per week)
Location: Remote

Responsibilities

• Verify patient eligibility and insurance benefits prior to scheduled appointments, including deductibles, copays, coinsurance, out-of-pocket maximums, and authorization requirements.
• Document and maintain accurate insurance and eligibility information in the appropriate systems.
• Research and resolve eligibility, insurance, and billing issues by working directly with insurance carriers, patients, families, and internal teams.
• Respond to patient and family inquiries regarding insurance coverage, statements, balances, claims, payments, and financial responsibility through phone, email, and other communication channels.
• Educate families on their insurance benefits, explanation of benefits (EOBs), patient responsibility, and available payment options.
• Guide patients through payment solutions, including payment plans and financing options such as Klarna, and assist with processing payments and documenting payment arrangements.
• Serve as a liaison between patients, Care Coordinators, Revenue Cycle, and insurance carriers to ensure accurate information is collected and issues are resolved promptly.
• Coordinate with internal teams to reschedule or cancel appointments when insurance coverage issues cannot be resolved prior to the visit.
• Review account activity, claims, payments, and adjustments to research and resolve billing inquiries accurately.
• Escalate complex eligibility or billing issues to the appropriate internal teams when additional investigation is needed.
• Deliver compassionate, professional, and timely customer service while handling sensitive financial and insurance-related conversations.
• Document all patient interactions thoroughly and accurately within internal systems.
• Identify recurring eligibility or billing trends and recommend process improvements to enhance the patient and family experience.
• Support other Revenue Cycle functions and special projects as business needs evolve.

Requirements

Must have…

• Prior experience in eligibility verification, patient billing, customer service, patient access, or revenue cycle management within healthcare, preferably behavioral or mental health.
• Experience working with commercial and/or Medicaid insurance plans.
• Strong customer service skills with the ability to explain insurance and billing information in a clear, compassionate manner.
• Excellent verbal and written communication skills.
• Strong organizational, problem-solving, and critical thinking skills.
• Ability to manage multiple priorities in a fast-paced environment.
• Ability to work independently while collaborating effectively across teams.
• Passion for supporting the mental health of students and families from diverse communities.

Nice to have…

• Proficiency in Spanish.
• Experience working with Apero.
• Experience with patient collections, payment plans, or financial counseling.
• Experience in pediatric mental health and/or school-based clinical services.
• Experience working with health insurance carriers in the states where Cartwheel operates.
• Experience working in a startup or high-growth healthcare environment.
• Experience working with health insurance carriers in the states in which Cartwheel currently operates (Massachusetts, Illinois, Ohio, New York, Connecticut and/or Rhode Island).

The above is a summary of the role, not an exhaustive list. If you think that you have most of the above but not everything, please apply. We'd love to hear from you.

Benefits

• Team-based culture with mission-driven colleagues who will go to bat for you
• Competitive cash compensation between $55,000 - $70,000
• Excellent health insurance
• Meaningful equity ownership stake
• Generous paid time off
• 401K with employer match
• $500 annual educational stipend
• Macbook

Pay

The base pay range for this role is $55,000 – $70,000 per year.