Benefits Eligibility Specialist

Access Supports•Middletown, NY

13h•Onsite

About The Position

The Benefits Eligibility Specialist is responsible for verifying, maintaining, and monitoring client insurance eligibility and payer information to support compliant billing and uninterrupted service delivery within an outpatient behavioral health setting. This role ensures accurate benefit verification, rate setup, and authorization tracking in alignment with Medicaid, managed care, commercial insurance, and regulatory requirements. The Benefits Eligibility Specialist must be able to work independently, prioritize competing tasks, and maintain strong attention to detail in a fast-paced clinical environment. Excellent communication, organizational skills, and the ability to collaborate effectively with clinical, billing, and administrative teams are essential.

Requirements

Minimum of 2 years’ experience in third-party eligibility verification within a healthcare or behavioral health setting.
Comprehensive knowledge of Medicaid, Medicare, Managed Care, and commercial insurance processes.
Working knowledge of insurance authorizations, reimbursement methodologies, and claims processes.
Knowledge of ICD-10, CPT, and HCPCS coding as it relates to outpatient behavioral health services.
Experience working within an Electronic Health Record (EHR) system.
Strong attention to detail and accuracy in data entry and documentation.
Ability to multitask and manage competing deadlines.
Proficient in Microsoft Office applications, particularly Excel.
Strong written and verbal communication skills.
Ability to maintain confidentiality in accordance with HIPAA regulations.
High School Diploma or equivalent required.

Nice To Haves

Associate degree in healthcare administration, business, or related field preferred.
Experience in behavioral health, outpatient clinic, or community-based healthcare strongly preferred.

Responsibilities

Reviews Insurance and Benefits Mailbox daily and enters new or updated client insurance information received from outpatient behavioral health staff into the Electronic Health Record (EHR).
Verifies client eligibility prior to intake and throughout treatment to ensure active coverage for outpatient behavioral health services.
Responds to benefit, eligibility, and authorization inquiries from clinical, intake, and billing staff in a timely manner.
Retrieves and reviews eligibility verification reports regularly and updates any changes in coverage within the EHR prior to claim submission.
Confirms payer requirements including authorizations, referrals, copays, deductibles, and service limitations.
Maintains current payer rate schedules and verifies accurate rate entry within the EHR to ensure compliant billing.
Assists with building, updating, and auditing rate tables and payer configurations within the EHR system.
Collaborates with billing department to resolve eligibility-related claim denials or rejections.
Monitors changes in Medicaid Managed Care, Medicare, and commercial insurance reimbursement policies impacting outpatient behavioral health services.
Prepares routine and management-requested reports related to client eligibility, payer trends, rate verification, and authorization tracking.
Maintains accurate and organized documentation in compliance with regulatory and audit standards.
Supports intake and clinical teams with insurance verification at point of admission.
Participates in internal audits and quality assurance initiatives related to payer compliance.
Assists with onboarding and training of staff regarding insurance verification workflows.
Performs other duties as assigned to support clinic operations and revenue cycle integrity.