Eligibility Screening Services Representative

Job Summary

The Eligibility Screening Services Representative is responsible for evaluating patients' eligibility for government, insurance, and financial assistance programs to facilitate access to healthcare services and appropriate reimbursement. This role meets with patients to gather financial and insurance information, assists with benefit applications, identifies potential payment sources, and documents eligibility activities. The Eligibility Representative collaborates with patients, hospital departments, and external agencies to support timely financial clearance while ensuring compliance with applicable regulations and organizational policies.

Essential Functions

• Meets with self-pay patients at their bedside to evaluate eligibility for Medicaid, Medicare, financial assistance, and other government or community assistance programs.
• Identifies and verifies potential payment sources, including commercial insurance, Medicare, Medicaid, Workers' Compensation, auto insurance, and third-party liability coverage.
• Assists patients in completing financial assistance applications and required documentation to support eligibility determinations.
• Reviews financial and insurance information to accurately route patient accounts and facilitate appropriate reimbursement processes.
• Documents patient interactions, eligibility screenings, application status, and supporting information in designated systems.
• Collaborates with Patient Access, Case Management, Social Services, Patient Financial Services, Patient Advocacy, and other departments to coordinate patient financial assistance activities.
• Maintains knowledge of eligibility requirements, payer guidelines, financial assistance programs, and applicable regulatory changes.
• Ensures compliance with organizational policies and applicable federal, state, and payer requirements while protecting patient confidentiality.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree or higher in a related field preferred
• 0-2 years of experience in healthcare, patient financial services, customer service, insurance verification, or a related field required
• Experience with Medicaid, Medicare, financial assistance programs, insurance verification, or patient accounting processes preferred
• Experience working in a hospital or healthcare environment preferred

Knowledge, Skills and Abilities

• Knowledge of healthcare insurance, government assistance programs, and patient financial services processes.
• Knowledge of patient confidentiality requirements and applicable healthcare regulations.
• Ability to gather, review, and analyze financial and insurance information.
• Strong customer service, communication, and interpersonal skills.
• Strong organizational skills with the ability to prioritize multiple tasks and maintain accurate documentation.
• Proficiency using computer applications, electronic medical records, and patient accounting systems.
• Ability to work independently and collaboratively while maintaining professionalism and compassion when assisting patients.

Licenses and Certifications

• Certification Application Counselor (CAC) through the Affordable Care Act (ACA) required

State Specific Requirements

• Georgia: Insurance Navigator license for residents of GA required
• Indiana: Insurance Navigator license for residents of IN required