Eligibility Specialist (Midtown)

About the role

Avenue 360 is a Federally Qualified Health Center (FQHC) dedicated to providing high-quality, compassionate care to promote healthy individuals and communities. Our holistic approach addresses medical needs, social challenges, and environmental factors, such as housing. We aim to ensure that income does not dictate access to quality healthcare. The core of our mission is to deliver comprehensive, high-quality, and caring services, encompassing medical care, hospice, adult activities, and supportive housing programs.

Responsibilities

• Perform all admissions activities, including intake, eligibility screenings, and reassessments.
• Ensure appropriate placement within Avenue 360’s continuum of care (medical, dental, behavioral health).
• Conduct financial assessments and document verification to maintain compliance with applicable regulations.
• Screen and evaluate individual and family needs for the purpose of developing or supporting care plans.
• Identify financial assistance, grant eligibility, or coverage programs that benefit the patient.
• Verify insurance eligibility through field calls, payer portals, and marketplace systems.
• Confirm grant program eligibility and update related documentation.
• Aid clients in completing applications for insurance programs and other community resources.
• Make timely, appropriate referrals and conduct follow-ups to support patient access to services.
• Update demographics, financial information, and eligibility documents at every visit or upon changes in circumstance.
• Ensure documentation is timely, accurate, and entered into the EHR and practice management systems.
• Provide back-up support for front desk operations, including scheduling, greeting patients, answering phones, and collecting payments.
• Respond to EHR in-basket messages and complete related work queue tasks.
• Participate in ongoing quality assurance and quality management activities.
• Maintain confidentiality, regulatory compliance, and adherence to organizational policies.
• Communicate with clinical and administrative teams to support care coordination.
• Absorb and manage efficient patient flow and operational efficiency.
• Provide cross-coverage to other clinics as needed.
• Adapt to changing priorities and assist with tasks outside of routine responsibilities as needed.
• Perform additional duties or special projects assigned to support organization operations.

Qualifications

• High school diploma or GED required.
• Minimum of 1 year of experience in a healthcare, customer service, or administrative setting.
• Experience working with patients, clients, or the public in a fast-paced environment preferred.
• Strong ability to multitask while maintaining accuracy and attention to detail.
• Demonstrated competency in communication, problem-solving, and maintaining professionalism under pressure.
• Soft skills such as empathy, adaptability, teamwork, and a service-oriented mindset.
• Proficiency with electronic health records (EHR) systems, scheduling software, and basic office technology and software preferred.
• Knowledge of community resources (primary care safety-net, social services, HIV/AIDS, homelessness, mental health/substance use) helpful.
• Bilingual proficiency in English and Spanish is preferred to support effective communication with patients.

Skills

• Strong communication and problem-solving skills.
• Attention to detail and multitasking abilities.
• Ability to maintain confidentiality and regulatory compliance.
• Teamwork and service-oriented mindset.
• Basic proficiency with electronic health records and office technology.

Benefits

Our organization offers a supportive and collaborative work environment, competitive compensation, and opportunities for professional growth and development.

Pay

Compensation is commensurate with experience and qualifications.

Schedule

The schedule is flexible to accommodate the needs of the clinic and the individual.