Eligibility Specialist

About the role

The Eligibility Specialist I plays a crucial role in helping uninsured and underinsured individuals access financial assistance for medical care. This role involves conducting detailed assessments, guiding patients through application processes for government and charity-funded programs, and ensuring compliance with healthcare regulations.

Responsibilities

• Conduct advanced eligibility screening in-person, including bedside visits, to assess financial assistance eligibility and provide compassionate guidance on available programs.
• Facilitate the application process for programs such as Medicaid, Medicare, Disability, hospital charity care or unique requirements for non-traditional funding, ensuring timely submission of accurate documentation.
• Act as a liaison between patients, hospital staff, and government agencies to establish eligibility, secure funding and resolve coverage issues.
• Perform advanced follow-up work across multiple hospital locations, ensuring applications are complete and processed efficiently.
• Identify and assist with technical medical requirements for disability programs, including setting up medical appointments, completing disability applications, submitting appeals, and following through on resolution of applications.
• Manage multiple patient cases independently, prioritizing tasks to meet deadlines and ensure effective follow-up on pending applications.
• Clearly communicate financial obligations, funding options, and program details to patients in an empathetic and professional manner.
• Maintain accurate and confidential records in compliance with HIPAA and organizational policies.
• Efficiently use multiple systems and databases to gather, track, and report on patient data.
• Identify and assist with complex cases, including disability applications, setting up appointments, and submitting appeals, etc. as needed.
• Absorb special projects, as assigned.

Requirements

• High school diploma or GED
• At least 6 months of experience in a customer-facing role, preferably in healthcare or financial counseling
• Flexibility to provide support to multiple hospital locations and in-home patient visits within assigned market area as based on operational needs
• Strong organizational skills with the ability to handle multiple priorities and maintain accuracy and attention to detail
• Excellent verbal and written communication skills, with the ability to explain complex information clearly and empathetically
• Ability to identify solutions to financial challenges, leveraging program knowledge to benefit patients
• Capability to work in a fast-paced environment with changing priorities and patient needs
• Demonstrated ability to work independently in locations where potentially only one Eligibility Specialist is assigned
• Demonstrate genuine care for patients’ needs and concerns, building trust and rapport
• Work effectively with colleagues, hospital staff, and external agencies to achieve shared goals
• Ensure all documentation is accurate, complete, and submitted on time
• Reliable transportation, a valid driver’s license, and ability to travel within assigned service area

Preferred

• Experience in healthcare revenue cycle, financial counseling, or insurance verification
• Experience with multiple EHR systems: Epic, Cerner, Meditech, etc.
• Familiarity with state and federal assistance programs such as Medicaid, Medicare, and Social Security Disability
• Knowledge of medical terminology and healthcare accounts receivable processes

Qualifications

• High school diploma or GED
• At least 6 months of experience in a customer-facing role, preferably in healthcare or financial counseling
• Flexibility to provide support to multiple hospital locations and in-home patient visits within assigned market area as based on operational needs
• Strong organizational skills with the ability to handle multiple priorities and maintain accuracy and attention to detail
• Excellent verbal and written communication skills, with the ability to explain complex information clearly and empathetically
• Ability to identify solutions to financial challenges, leveraging program knowledge to benefit patients
• Capability to work in a fast-paced environment with changing priorities and patient needs
• Demonstrated ability to work independently in locations where potentially only one Eligibility Specialist is assigned
• Reliable transportation, a valid driver’s license, and ability to travel within assigned service area

Skills

• Customer service skills
• Communication skills
• Organizational skills
• Financial counseling skills
• Healthcare knowledge

Benefits

Not specified

Pay

$18.00 to $20.00 per hour

Schedule

Full time, 40 hours per week, hourly position. Flexibility required, with shift available between Monday through Saturday from 8:00am to 7:00pm, to meet business needs.