Department: Administration
Reports To: Chief Financial Officer (CFO)
The Eligibility Specialist assists patients in understanding and accessing available healthcare coverage and financial assistance programs, with a primary focus on Medicare, Medicaid, and the Health Care Partners of South Carolina Sliding Fee Discount Program. This position conducts eligibility screenings, verifies insurance coverage, educates patients on available assistance programs, and provides guidance throughout the enrollment and renewal processes. The Eligibility Specialist works collaboratively with patients, clinical staff, registration, billing, and community partners to help reduce financial barriers to care while maintaining compliance with HRSA, FQHC, HIPAA, and organizational policies.
· Screen patients for eligibility for Medicare, Medicaid, the Sliding Fee Discount Program, and other federal, state, or local assistance programs.
· Educate patients on available healthcare coverage, financial assistance programs, eligibility requirements, enrollment timelines, and required documentation.
· Guide patients through enrollment and renewal processes while ensuring patients complete and submit all required applications and supporting documentation.
· Verify insurance eligibility and accurately maintain patient demographic and insurance information in the Electronic Health Record (EHR).
· Maintain accurate documentation of eligibility determinations, applications, renewals, referrals, and follow-up activities in compliance with FQHC, HRSA, and organizational standards.
· Collaborate with the Sliding Fee Discount Program team to ensure patients are enrolled in the most appropriate financial assistance program based on eligibility.
· Coordinate with registration, billing, clinical staff, and external agencies to resolve insurance eligibility and coverage issues.
· Monitor insurance coverage and financial assistance renewal dates and assist patients with renewal preparation to help prevent interruptions in care.
· Maintain patient confidentiality and protect health information in accordance with HIPAA and organizational policies.
· Stay current on Medicare, Medicaid, HRSA, Sliding Fee Discount Program requirements, and other applicable eligibility guidelines and regulations.
· Participate in required trainings, staff meetings, and organizational quality improvement initiatives.
· Perform other duties as assigned.
· High school diploma or equivalent required; Associate degree in Healthcare Administration, Business Administration, Social Services, Public Health, or a related field preferred.
· Minimum of two (2) years of experience in healthcare eligibility, insurance verification, patient financial services, patient access, or a related healthcare setting required.
· Experience working in a Federally Qualified Health Center (FQHC) or community health center preferred.
· Working knowledge of Medicare, Medicaid, insurance verification, and Electronic Health Record (EHR) systems required.
· Knowledge of Medicare, Medicaid, healthcare insurance programs, and patient financial assistance resources.
· Knowledge of HRSA requirements, Sliding Fee Discount Program guidelines, and HIPAA regulations.
· Excellent customer service, communication, and interpersonal skills with a commitment to providing compassionate, patient-centered care.
· Strong organizational skills with the ability to manage multiple priorities while maintaining accuracy and attention to detail.
· Proficiency in Microsoft Office and Electronic Health Record (EHR) systems.
· Ability to exercise sound judgment, maintain confidentiality, solve problems effectively, and establish positive working relationships with patients, staff, and community partners.
Health Care Partners of South Carolina is an Equal Opportunity Employer. We are committed to fostering a diverse and inclusive workplace and encourage qualified applicants from all backgrounds to apply.