Eligibility Specialist

Role Overview

• Conduct advanced eligibility screening to assess financial assistance eligibility and provide compassionate guidance on available programs.
• Facilitate the application process for programs such as Medicaid, Medicare, Disability, hospital charity care or unique requirements for non-traditional funding, ensuring timely submission of accurate documentation.
• Act as a liaison between patients, hospital staff, and government agencies to establish eligibility, secure funding and resolve coverage issues.
• Perform advanced follow-up work across, ensuring applications are complete and processed efficiently.
• Identify and assist with technical medical requirements for disability programs, including setting up medical appointments, completing disability applications, submitting appeals, and following through on resolution of applications.
• Manage multiple patient cases independently, prioritizing tasks to meet deadlines and ensure effective follow-up on pending applications.
• Clearly communicate financial obligations, funding options, and program details to patients in an empathetic and professional manner.
• Maintain accurate and confidential records in compliance with HIPAA and organizational policies.
• Consistently achieve productivity and quality metrics, contributing to the organization's financial counseling objectives.
• Efficiently use multiple systems and databases to gather, track, and report on patient data.
• Identify and assist with complex cases, including disability applications, setting up appointments, and submitting appeals, etc. as needed.
• Assist in training and supporting colleagues as needed, ensuring seamless onboarding and service delivery.
• Complete special projects, as assigned.

Requirements

• High school diploma or GED
• At least 2 years of experience in a customer-facing role, preferably in healthcare or financial counseling.
• Flexibility to provide support to multiple hospital locations and in-home patient visits within assigned market area as based on operational needs.
• Strong organizational skills with the ability to handle multiple priorities and maintain accuracy and attention to detail.
• Excellent verbal and written communication skills, with the ability to explain complex information clearly and empathetically.
• Ability to identify solutions to financial challenges, leveraging program knowledge to benefit patients.
• Capability to work in a fast-paced environment with changing priorities and patient needs.
• Demonstrated ability to work independently in locations where potentially only one Eligibility Specialist is assigned.
• Demonstrate genuine care for patients’ needs and concerns, building trust and rapport.
• Work effectively with colleagues, hospital staff, and external agencies to achieve shared goals.
• Ensure all documentation is accurate, complete, and submitted on time.
• Reliable internet connection and a secure workspace.