Eligibility Specialist - PRN, As Needed

Responsibilities

• Maintain up-to-date knowledge of regulations involving government sponsored programs, hospital charity care policies, and other financial assistance programs, including eligibility criteria and application procedures.
• Assess patients’ financial situations to determine eligibility for government sponsored programs, charity care, or other financial assistance programs through interviews, document reviews, and verification processes.
• Guide patients through the completion and submission of applications for government sponsored programs, hospital charity care, and other relevant programs, ensuring all required documentation is accurate and complete.
• Act as a liaison between patients and program administrators, advocating for patients to ensure timely processing of applications and resolution of issues.
• Maintain accurate and confidential records of patient interactions, eligibility assessments, and application statuses in compliance with hospital policies and applicable regulations.
• Educate patients and families about available financial assistance options, explaining complex program details in a clear and empathetic manner.
• Work closely with hospital billing, social work, and case management teams to coordinate patient care and financial support services.
• Ensure all activities adhere to federal, state, and hospital regulations, including HIPAA, regarding patient privacy and financial assistance processes.
• Verify and correctly assign insurance coverages based on eligibility responses.
• Perform all other duties as assigned.

Qualifications

• Minimum of two (2) years of experience in healthcare, social services, insurance, or government payor programs preferably in patient financial services or case management.
• Strong understanding of government sponsored programs, insurance, and charity care programs or ability to quickly learn program requirements.
• Excellent communication and interpersonal skills to interact with diverse patient populations.
• Detail-oriented with strong organizational skills to manage multiple applications and deadlines.
• Proficiency in Microsoft Office and electronic health record (EHR) systems.
• Ability to handle sensitive information with confidentiality and professionalism.
• Compassionate, patient-focused, and ability to work effectively under pressure in a fast-paced hospital environment.
• High school diploma or equivalent required.
• Associate’s or bachelor’s degree in healthcare administration, social work, or related field preferred.

Schedule

PRN, As Needed