Eligibility & Benefits Specialist

Key Responsibilities

Patient Eligibility and Benefits Coordination

1. Verify patient insurance eligibility for all scheduled visits, including primary, secondary, and tertiary coverage, using electronic systems and payer portals.
2. Confirm accurate assignment of contracted IPA or medical group under the patient’s plan and update payer IDs within the EHR to prevent billing delays or denials.
3. Review benefit coverage for medical, behavioral health, family planning, and specialty services.
4. Document all verification and benefit details in the EHR clearly and accurately prior to appointments.
5. Contact patients to notify them of insurance or eligibility changes prior to scheduled visits.
6. Screen uninsured and underinsured patients for applicable assistance programs and sliding fee options by reviewing income and household documentation.
7. Educate patients on available coverage options and financial responsibilities.
8. Coordinate and assist patients with primary care provider (PCP) changes as needed.
9. Consistently adheres to a high standard of professional ethics; conducts self in an ethical manner and is a role model to others.
10. Schedule, canceled or reschedule patients if needed according to their eligibility.
11. Attend all staff meetings and assigned trainings.
12. Perform other related duties as assigned.

Customer Service and Collaboration

• Provide courteous and professional assistance to patients, payers, and internal staff at all times.
• Act as a liaison between patients, providers, and external agencies to resolve coverage and benefit concerns.
• Participate in team meetings, quality improvement initiatives, and staff training.
• Perform other related duties as assigned to support the revenue cycle and patient access functions.

Skills / Competencies

1. Customer Service
2. Attention to Detail
3. Thoroughness
4. Organizational Skills
5. Communication

Required Skills & Qualifications

Education and Experience

• Bachelor’s Degree preferred
• 3 years of healthcare experience (preferred – Eligibility & Benefits)
• Excellent verbal communication and phone etiquette skills.
• Strong organizational skills with the ability to manage multiple tasks at once.
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
• Professional, friendly, and customer-focused demeanor.
• Ability to maintain confidentiality and handle sensitive information appropriately.
• Strong problem-solving skills and the ability to think on your feet.
• Ability to work independently and in a team environment.
• Excellent communication skills (verbal and written).
• Excellent customer service and problem-solving skills.
• Excellent organizational skills with the ability to multi-task.
• Basic computer skills (Microsoft Applications, Internet Applications)
• Ability to display adaptability, empathy, patience, and has a positive attitude.

Skills Required

• Good understanding of medical terminology.
• Basic Computer Skills (Microsoft Office, Internet Applications).
• Clear and effective communication skills.
• Able to display adaptability, empathy, patience, and has a positive attitude.
• Fast learner with great attention to detail.
• Fosters and promotes a culture of service excellence and accountability.
• Consistently adheres to a high standard of professional ethics; conducts self in an ethical manner and is a role model to others.
• Promotes and believes in the company’s mission statement: “Helping People Heal.”
• Believe and aligns with the company’s core values: Compassion, Respect, Integrity, Accountability, and Teamwork.
• Treats everyone equally regardless of racial, ethnic, religious, social, and economic status or background.
• Performs all job functions in a professional and courteous manner.

Physical Demands

This is mostly in an office setting; however, this position may require sitting for long periods of time. Walking, bending and reaching may be required as well. While performing the duties of this job, this position is frequently required to do the following:

• Use standard office equipment and access, input, and retrieve information from a computer. Use computer keyboard with manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions efficiently for extended periods of time.
• Communicate effectively in person or via telephone in a manner which can be understood by those with whom the person is speaking, including a diverse population.
• Give and follow verbal and written instructions with attention to detail and accuracy.
• Perform basic arithmetic functions.
• Vision: see details of objects at close range.
• Coordinate multiple tasks simultaneously.
• Reach forward, up, down, and to the side.