Eligibility and Insurance Verification Specialist

Triangle Area Network Inc•Beaumont, TX

4d•$16 - $19

About The Position

The Eligibility and Insurance Verification Specialist supports access to TAN Healthcare behavioral health services, including medication management and counseling. During assigned part-time hours, the specialist completes patient registration, insurance verification, financial eligibility screening, and scheduling support. The role works with patients, billing staff, front desk staff, and clinical teams to reduce barriers to care, maintain accurate eClinicalWorks records, and support TAN Healthcare’s mission of All Care All People. This is an administrative position that supports patient access, behavioral health coordination, and patient-centered care. The specialist uses respectful, trauma-informed communication, protects confidential information, follows TAN policies and applicable privacy requirements, and promptly routes safety concerns or urgent symptoms to designated clinical staff. The role does not provide clinical triage or counseling.

Requirements

High school diploma or GED.
Demonstrated knowledge of insurance benefits and verification.
Strong attention to detail, organization, follow-through, and professional oral and written communication.
Proficiency with computer navigation, Microsoft Office, payer portals, electronic records, and general office equipment.
Ability to manage multiple telephone lines and competing priorities.
Ability to work effectively with diverse patients, including uninsured and underserved populations.
Meet applicable background screening and post-offer occupational health requirements under TAN policies.

Nice To Haves

Medical assistant training or certification.
Prior healthcare experience and/or two years of insurance verification experience.
Behavioral health insurance and authorization experience.
Spanish speaking and writing skills.

Responsibilities

Engage new and established patients by telephone and in person; explain TAN services and approved intake requirements.
Assist patients with registration packets and administrative forms, and enter or update patient information and supporting documents in eClinicalWorks.
Schedule appointments within approved provider templates, communicate preparation requirements, and route clinical scheduling questions appropriately.
Assist with patient portal setup, arrange approved language assistance, and communicate accessibility or other barriers to the appropriate team.
Document outreach attempts, unresolved needs, and next steps, and provide clear handoffs.
Verify insurance coverage, payer and plan information, provider participation, benefits, patient responsibility, and behavioral health coverage details using approved resources.
Explain PCP assignment change processes when needed and document assistance and status.
Document verification findings and follow-up needs; reverify coverage as required by TAN workflows or coverage changes.
Explain the Sliding Fee Discount Program, assess eligibility based on income and family size under approved policies, collect supporting information, and document reassessments.
Explain approved financial information and escalate missing documentation, disputed determinations, inactive coverage, and inability-to-pay concerns.
Coordinate with behavioral health staff and billing on referrals, authorizations, visit counts, and expiration dates; obtain authorizations only when assigned and trained.
Support intake, follow-up scheduling, and missed-appointment outreach under approved workflows while protecting sensitive information.
Route reported safety concerns, urgent symptoms, or crisis statements to designated clinical staff and follow TAN emergency procedures.
Hand off pending benefits checks, authorizations, and patient needs before scheduled time off.
Support the Patient Centered Medical Home model through timely access, continuity, coordinated communication, and connections to primary care and community resources.
Perform assigned duties consistent with TAN policies and applicable HRSA Health Center Program requirements, including equitable access, sliding-fee processes, accurate records, and quality improvement.
Protect confidential information under HIPAA and other applicable privacy requirements; use approved systems, verify identity and authority before disclosures, and access only information needed for assigned duties.
Complete required training, cooperate with audits and record reviews, and promptly report errors, privacy concerns, safety issues, and suspected noncompliance.
Demonstrate reliability, collaboration, knowledge, innovation, and compassion; cross-train and provide administrative coverage as assigned within training and role boundaries; perform other related duties as assigned.