Eligibility and Insurance Verification Specialist

Triangle Area Network Inc•Beaumont, TX

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. The specialist engages patients by telephone and in person, assists with registration and intake requirements, schedules appointments, supports patient portal access, and arranges approved language assistance. Responsibilities also include verifying medical and behavioral health insurance benefits, assessing eligibility for the Sliding Fee Discount Program under approved policies, coordinating referrals and authorizations, tracking follow-up items, and ensuring clear handoffs between part-time shifts. The position supports patient-centered, coordinated care while following TAN policies and applicable HRSA Health Center Program requirements. It requires protecting confidential information under HIPAA and other applicable privacy requirements, using approved systems and procedures, completing required training, cooperating with audits, and reporting errors, privacy concerns, safety issues, and suspected noncompliance. This is an administrative position and 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 with compassion, professionalism, and respect, and explain TAN services and approved intake requirements.
Assist patients with registration packets and administrative forms; enter and update demographics, contact information, insurance information, and supporting documents in eClinicalWorks.
Schedule appointments within approved provider templates and workflows, communicate preparation requirements, and route clinical scheduling questions to the appropriate team.
Assist with patient portal setup and access, 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 active insurance coverage, effective dates, payer and plan information, provider participation, benefits, copayments, deductibles, and other patient responsibility using approved payer resources.
Verify behavioral health benefits separately when administered by another payer or benefit manager, including benefits for counseling and medication management, telehealth coverage, visit limits, referral requirements, and authorization requirements.
Explain the approved process for PCP assignment changes, provide appropriate information or forms, document assistance and status, and communicate unresolved issues before appointments when possible.
Document verification dates, sources or reference numbers, findings, and follow-up needs; reverify coverage when required by TAN workflows or when coverage changes.
Explain the Sliding Fee Discount Program to insured and uninsured patients and assess eligibility based on income and family size using TAN’s approved policies and current schedule.
Obtain and document supporting financial information and reassessments under approved procedures; escalate missing documentation, disputed determinations, inactive coverage, and inability-to-pay concerns.
Coordinate with behavioral health staff and billing regarding required referrals, authorizations, approved visit counts, and expiration dates.
Track and communicate pending items within assigned workflows, and obtain authorizations only when assigned and trained.
Support new-patient intake, follow-up scheduling, and outreach for missed appointments under approved workflows while protecting sensitive information.
Use respectful, trauma-informed communication and immediately route reported safety concerns, urgent symptoms, or crisis statements to designated clinical staff while following TAN emergency procedures.
Document completed work and 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 connection to primary care and community resources.
Coordinate with primary care teams regarding behavioral health patients as appropriate under approved privacy and consent procedures.
Carry out duties consistent with TAN policies and applicable HRSA Health Center Program requirements, including equitable access, sliding-fee processes, accurate records, and quality improvement participation.
Protect confidential information under HIPAA and other applicable privacy requirements; 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 through established channels.
Demonstrate reliability, collaboration, knowledge, innovation, and compassion.
Crosstrain and provide administrative coverage as assigned within training and role boundaries, and perform other related duties as assigned.