The Insurance & Financial Eligibility Specialist is responsible for accurately and timely determining financial and insurance eligibility for clients/patients receiving services across assigned programs. This position verifies insurance coverage and benefits, determines financial responsibility and program eligibility, and ensures required documentation is complete and maintained in accordance with HIPAA, organizational policies, and funding source requirements.
Benefits:
Health Insurance starting your first day
401k plan including employer match
Competitive Time Off Benefits
Hourly pay range: $18 - $20
Responsibilities:
Determine financial eligibility for clients applying for services across assigned programs in accordance with program guidelines and funding requirements.
Verify patient insurance coverage, eligibility, effective dates, plan type, covered services, and benefit limitations prior to appointments or services.
Confirm copays, deductibles, coinsurance, out-of-pocket maximums, and other applicable patient financial responsibilities.
Identify prior authorization, pre-certification, referral, or other payer requirements and obtain necessary approvals when applicable.
Review and validate eligibility documentation and request additional information when necessary.
Check for secondary or tertiary insurance coverage and coordinate benefits as appropriate.
Communicate eligibility determinations and coverage information to clients/patients, program staff, providers, front-desk staff, billing personnel, and other relevant departments in a timely and professional manner.
Assist clients/patients in understanding eligibility requirements, required documentation, insurance benefits, and financial responsibility.
Maintain accurate and complete eligibility and insurance information in applicable electronic health record, billing, and program systems.
Document verification results, authorization information, payer communications, and supporting documentation in accordance with established procedures.
Monitor re-certification dates and request updated financial, insurance, and program documentation as needed to maintain continued eligibility.
Resolve eligibility discrepancies by communicating with insurance carriers, clients/patients, providers, and internal departments.
Assist with claim resolution and eligibility-related denials by providing accurate insurance and eligibility information.
Collaborate with intake staff, case managers, clinical teams, billing, compliance, credentialing, and other departments to ensure accurate eligibility determination and clean claims.
Maintain current knowledge of payer requirements, insurance processes, program eligibility guidelines, and applicable organizational policies.
Maintain strict confidentiality and safeguard protected health information and other sensitive client/patient information.
Ensure all documentation and eligibility activities comply with HIPAA, organizational policies, funding source requirements, and applicable regulatory standards.
Perform other duties as assigned or directed.
Requirements High school diploma or GED required, with a combination of education and experience normally represented by at least one year of relevant experience.
Prior experience in medical billing, insurance verification, financial eligibility, healthcare administration, or customer service in a healthcare or human services setting preferred.
Working knowledge of medical billing systems and electronic health record (EHR/EMR) systems preferred.
Knowledge of health insurance coverage, eligibility, benefits, reimbursement processes, and prior authorization requirements.
Familiarity with HIPAA privacy requirements and the appropriate handling of protected health information.
Strong oral, written, and interpersonal communication skills.
Strong organizational skills and attention to detail, with the ability to manage multiple priorities and deadlines.
Ability to analyze and interpret eligibility, insurance, and financial information accurately.
Ability to maintain confidentiality and exercise sound judgment when handling sensitive information.
Demonstrated patience, courtesy, and professionalism when working with clients/patients and the public.
Strong telephone and client/patient service skills.
Ability to work effectively with a diverse client population, community organizations, insurance carriers, and staff at all levels.
Good working knowledge of computers and Microsoft Office applications.
Ability to learn and navigate payer portals, electronic health records, billing systems, and other technology platforms.
Final applicant is required to be fingerprinted to complete a background check.
Working Conditions and Physical Demands:
Normal office environment.
Frequent sitting, talking, and listening/hearing.
Frequent use of computers, telephones, and/or cell phones.
Reading, writing, and finger dexterity required for correspondence, faxing, copying, forms/documents, data entry, answering phones, computer applications, and maintaining client/patient files.
Ability to visually perceive and discern information presented in electronic and written formats.
Ability to organize and coordinate schedules and manage multiple tasks.
Ability to analyze and interpret data and documentation.
Regular communication with clients/patients, insurance carriers, community organizations, and the public.
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