Eligibility Enrollment Specialist

Texas Health Action•San Antonio, TX

2d•Hybrid

About The Position

Texas Health Action (THA) is a community-informed non-profit organization dedicated to providing access to culturally affirming, quality health services in a safe and supportive environment, with expertise in serving LGBTQIA+ people and those impacted by HIV. Kind Clinic proudly serves Texas with four vibrant locations: two in Austin, one in San Antonio, and another in Dallas plus virtual care services available to all residents across Texas. Bolstered by Waterloo Counseling Center and a passionate team of over 250 dedicated employees and volunteers, THA is at the forefront of promoting healthcare equity and accessibility throughout the state. Texas Health Action is seeking applicants for an Eligibility Enrollment Specialist, working under the direction of the Director of Patient Support Services. The Eligibility Enrollment Specialist is responsible for assisting patients and community members with identifying, applying for, enrolling in, and maintaining eligibility for Texas Health Action internal assistance programs and external healthcare and community assistance programs. This position provides direct patient support to reduce financial, administrative, and access-related barriers to care. The Eligibility Enrollment Specialist conducts eligibility screenings, verifies required documentation, educates patients about available programs, completes and submits applications, coordinates referrals, and follows applications through determination and renewal. Programs may include Central Health’s Medical Access Program (MAP) and MAP Basic, Texas Health Action assistance programs, medication and pharmaceutical assistance programs, healthcare coverage resources, and other local, state, federal, nonprofit, or community-based programs for which patients may qualify. This position is available in Austin (Central and South locations), San Antonio, and remotely for candidates residing in Texas.

Requirements

High school diploma or equivalent required
Minimum of 1 year of experience in healthcare, patient services, benefits navigation, eligibility determination, enrollment, financial assistance, case management, or a related customer service role preferred.
Experience assisting individuals with applications for healthcare coverage, financial assistance, public benefits, medication assistance, or community-based programs preferred.
Experience reviewing and verifying eligibility documentation, including income, residency, household, and insurance information.
Experience working directly with patients or clients from diverse backgrounds and navigating sensitive financial or personal circumstances with professionalism and discretion.

Nice To Haves

associate or bachelor’s degree in healthcare, social services, public health, human services, or a related field preferred.
Bilingual English/Spanish skills preferred.

Responsibilities

Conduct comprehensive eligibility screenings to identify internal and external assistance programs for which patients may qualify.
Verify income, residency, household composition, insurance status, and other documentation required to establish program eligibility.
Assist patients with enrollment and renewal for Central Health MAP and MAP Basic, including completing and submitting applications through the Central Health/VeritySource system.
Screen and enroll eligible patients in Texas Health Action internal assistance programs and other organizational resources designed to improve access to care.
Assist patients with completing applications, gathering supporting documentation, submitting required materials, and navigating enrollment systems.
Educate patients about available programs, eligibility requirements, benefits, required documentation, renewal timelines, and responsibilities for maintaining eligibility.
Help patients understand their available assistance options and determine which programs best meet their healthcare and financial needs.
Track pending applications, referrals, eligibility determinations, approvals, denials, and renewals through completion.
Proactively follow up with patients to obtain missing information or documentation and help prevent delays or interruptions in assistance.
Assist patients with resolving enrollment barriers, including incomplete applications, documentation issues, eligibility questions, requests for additional information, and denials.
Maintain accurate and timely documentation of screenings, applications, referrals, enrollment outcomes, and patient interactions in approved electronic systems.
Coordinate with clinic teams, Patient Support Services and other departments to facilitate access to care following enrollment or approval.
Maintain current knowledge of internal and external assistance programs, including eligibility criteria, benefits, application procedures, documentation requirements, and renewal processes.
Maintain familiarity with community resources that address barriers to healthcare and other supportive service needs.
Provide patient-centered and culturally responsive assistance while helping individuals navigate complex eligibility and enrollment processes.
Maintain compliance with HIPAA, organizational privacy and confidentiality standards, program requirements, and applicable regulations.
Identify recurring eligibility and enrollment barriers and communicate trends and resource gaps to Patient Support Services leadership.
Perform other eligibility determination, enrollment, patient assistance, benefits navigation, and resource coordination duties as assigned.