Eligibility Enrollment Specialist

About the role

Texas Health Action (THA) is seeking an Eligibility Enrollment Specialist to assist patients and community members with identifying, applying for, enrolling in, and maintaining eligibility for various assistance programs. This is a fixed 6-month position as a 1099 independent contractor and does not include employee benefits.

Responsibilities

• Conduct comprehensive eligibility screenings to identify internal and external assistance programs for which patients may qualify
• Verify income, residency, household composition, insurance status, and other documentation required to establish program eligibility
• Absorb and enroll eligible patients in Texas Health Action internal assistance programs and other organizational resources designed to improve access to care
• Absorb and assist patients with completing applications, gathering supporting documentation, submitting required materials, and navigating enrollment systems
• Education patients about available programs, eligibility requirements, benefits, required documentation, renewal timelines, and responsibilities for maintaining eligibility
• Absorb and assist patients with resolving enrollment barriers, including incomplete applications, documentation issues, eligibility questions, requests for additional information, and denials
• Maintain accurate and timely documentation of screenings, applications, referrals, enrollment outcomes, and patient interactions in approved electronic systems
• Coordinate with clinic teams, Patient Support Services and other departments to facilitate access to care following enrollment or approval
• Maintain current knowledge of internal and external assistance programs, including eligibility criteria, benefits, application procedures, documentation requirements, and renewal processes
• Maintain familiarity with community resources that address barriers to healthcare and other supportive service needs
• Provide patient-centered and culturally responsive assistance while helping individuals navigate complex eligibility and enrollment processes
• Maintain compliance with HIPAA, organizational privacy and confidentiality standards, program requirements, and applicable regulations
• Identify recurring eligibility and enrollment barriers and communicate trends and resource gaps to Patient Support Services leadership
• Perform other eligibility determination, enrollment, patient assistance, benefits navigation, and resource coordination duties as assigned

Requirements

• High school diploma or equivalent required; associate or bachelor's degree in healthcare, social services, public health, human services, or a related field preferred
• Minimum of 1 year of experience in healthcare, patient services, benefits navigation, eligibility determination, enrollment, financial assistance, case management, or a related customer service role preferred
• Experience assisting individuals with applications for healthcare coverage, financial assistance, public benefits, medication assistance, or community-based programs preferred
• Experience reviewing and verifying eligibility documentation, including income, residency, household, and insurance information preferred
• Experience working directly with patients or clients from diverse backgrounds and navigating sensitive financial or personal circumstances with professionalism and discretion preferred
• Bilingual English/Spanish skills preferred