Eligibility Enrollment Specialist
About The Position
Texas Health Action is seeking an Eligibility Enrollment Specialist to work under the direction of the Director of Patient Support Services. This position assists 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. The role provides direct patient support to reduce financial, administrative, and access-related barriers to care. Duties include conducting eligibility screenings, verifying documentation, educating patients about programs, completing and submitting applications, coordinating referrals, and following 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. This is a fixed six-month position engaged as a 1099 independent contractor; employee benefits are not included. The schedule is Monday through Friday during clinic hours, or part-time as needed. The position is available in Austin (Central and South locations), San Antonio, and remotely for candidates residing in Texas. The starting hourly rate is $22.93, with the initial rate determined by the selected candidate’s qualifications and relevant experience.
Requirements
- High school diploma or equivalent required.
- 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.
- At least one year of experience in healthcare, patient services, benefits navigation, eligibility determination, enrollment, financial assistance, case management, or a related customer service role.
- Experience assisting individuals with applications for healthcare coverage, financial assistance, public benefits, medication assistance, or community-based programs.
- Bilingual English/Spanish skills.
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.
- Help patients complete applications, gather supporting documentation, submit required materials, and navigate enrollment systems.
- Educate patients about available programs, eligibility requirements, benefits, required documentation, renewal timelines, and responsibilities for maintaining eligibility.
- Help patients understand their 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.
- 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 as individuals navigate 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.
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What This Job Offers
Job Type
Part-time
Education Level
High school or GED
