Patient Benefits Specialist

We are an equal opportunity employer. All qualified applicants will receive consideration for employment. We do not discriminate for any reason. We welcome talented individuals who believe in our mission, drive the organization forward, and recognize the positive impact they can bring to our communities.

This role requires travel to ACCESS A-Z, ACCESS Martin Russo, and ACCESS Addison

Position Summary

Patient Benefit Specialist (PBS) is responsible for working directly with patients to ensure a clear understanding of insurance coverage, financial responsibilities, and available payment options. This role plays a key part in maximizing ACCESS' reimbursement through accurate benefit assessment and effective patient guidance. The Patient Benefit Specialist conducts comprehensive screening and intake processes to help determine patient eligibility for healthcare programs, grants, and coverage options. As an integral member of the patient care team, the Patient Benefit Specialist supports patients in navigating the revenue cycle, ensuring access to appropriate financial resources while promoting a seamless care experience.

Core Job Responsibilities

• Conduct benefit orientation and explain financial requirements to ensure full understanding of benefit program and patient responsibilities. Obtain all necessary forms, documents, and signatures as required.
• Conduct comprehensive financial assessment interviews to screen patients for healthcare benefits, insurance coverage, and eligibility for grants or assistance programs; clearly communicate all available options to patients and their families.
• Verify patients' existing third‑party and other healthcare coverage to identify current benefits, determine coverage gaps, and provide clear explanations to help patients understand their insurance options.
• Assist patient/family with program enrollment, based on financial assessment/screening results and option selection.
• Enter and update patient benefit‑coverage information in the EHR based on findings from benefits assessments and screenings. Scan and upload all required forms and documentation, ensuring complete accuracy and 100% compliance with organizational and regulatory standards.
• Maintain current knowledge of Medicare, Medicaid, Marketplace and private insurance, HMO, and Sliding Fee Scale rules and regulations.
• Assist patients with Medicaid applications and follow up yearly for redetermination.
• Communicate with providers, medical assistants, and other employees using a team-based approach to coordinate patient care. Work effectively as part of the health care team, and as an advocate for patients and their families.
• Assist patients with navigating the revenue cycle process as appropriate. Act in the best interests of patients always, providing direct support and guidance when possible. When this support is out of scope, provide a warm hand-off to the appropriate party
• Always uphold patient confidentiality and HIPAA standards. Defuse irate callers and patients by working with them to identify and properly address concerns.
• Other duties as assigned.

Requirements/Preferences

• High School diploma or GED required.
• Minimum of two (2) years of customer service experience required.
• Prior experience with All Kids and Moms & Babies (MPE) programs preferred.
• Knowledge of Medicare, Medicaid, Marketplace insurance, and HMO regulations preferred.
• Knowledge of Electronic Health Records (EHR), especially EPIC, preferred.
• Intermediate proficiency in Microsoft Office products (e.g., Word, Excel, Outlook) required.
• Ability to communicate clearly and effectively with diverse patients.
• Strong organizational and multitasking skills are essential.
• Bilingual in English and Spanish preferred.

Working Conditions/Equipment

• Works regularly in a standard office environment and occasionally in a health center setting.
• Local travel between health centers and community events is required; reliable transportation is necessary.

Benefits

• Tuition reimbursement and student loan forgiveness programs for qualifying individuals
• Comprehensive healthcare coverage including Medical, Dental, and Vision
• Generous PTO
• 403(B) retirement plan and financial resources to help you save and plan for your retirement
• Life Insurance
• Opportunity to participate in cross-departmental committees to innovate and transform our care delivery model and our workplace

ACCESS is a Network of Federally Qualified Health Centers treating patients on the frontlines of community-based health care. Depending on position applied/being recruited for, candidates may be required to be vaccinated against communicable diseases and provide supporting documentation proving that they are properly vaccinated, or apply for religious and/or medical vaccination exemption as a part of the application process.

The pay ranges provided represent the minimum to mid-range for positions. Actual compensation will be determined based on a combination of factors including years of experience, educational background, market conditions, and available grant funding.