Enrollment Benefits Specialist

North Central Health Care•Town of Wausau, WI

8d•$19 - $21•Onsite

About The Position

The Enrollment Benefit Specialist plays a critical role in supporting access to care by ensuring accurate, timely, and compliant enrollment, insurance verification, and benefit coordination for inpatient and outpatient services. This position is responsible for verifying insurance coverage, identifying authorization requirements, obtaining required consents and legal documentation, and assisting clients in understanding financial responsibilities and available assistance programs. The Enrollment Benefit Specialist works collaboratively with clinical teams, Patient Accounts, Health Information Management, and external payers to ensure regulatory compliance, accurate data entry, and a seamless registration and intake process for clients and their authorized representatives.

Requirements

High School Diploma or equivalent
More than 1 year of customer service experience in healthcare, insurance, or a closely related field.
Working knowledge of insurance plans, eligibility verification, and billing practices

Nice To Haves

Associate’s Degree in a healthcare-related field
More than 1 year of experience with medical billing, registration, or enrollment processes
Experience working with diverse patient populations, including individuals with mental health and substance use disorders

Responsibilities

Complete all aspects of the enrollment process for outpatient and inpatient admissions, hospital discharges, and walk-in or scheduled intakes.
Verify insurance eligibility, benefits, co-payments, deductibles, and authorization requirements using payer portals and eligibility systems.
Identify services requiring prior authorization and initiate the authorization process or route information to appropriate staff.
Review daily appointment schedules in advance to ensure accurate demographic, insurance, authorization, and guarantor information.
Contact guardians of ant minor patient to ensure guardian attendance during appointments.
Resolve insurance discrepancies to support timely and accurate billing.
Meet with clients, guardians, or power of attorney representatives to obtain required signatures and documentation, including but not limited to: Informed consent for services, Rights and notices, Releases of information, Financial responsibility documents, Medicare-related notices and forms.
Verify guardianship and legal status and ensure appropriate documentation is maintained in the electronic medical record (EMR).
Ensure completeness and accuracy of registration information entered by other departments and make corrections as needed.
Maintain and review Ability to Pay (ATP) information, including income documentation and financial reviews.
Communicate ATP determinations to clients through in-person discussions, phone calls, and written correspondence.
Collaborate with Patient Accounts regarding payment plans, financial assistance options, and account updates.
Collaborate with providers, referral coordinators, and external partners to ensure enrollment requirements are met prior to scheduling services, including school-based and telehealth services.
Mail any required enrollment, crisis, or discharge packets as applicable.
Maintain ongoing communication with internal departments to ensure accurate client status updates.
Accurately enter and update demographic, insurance, encounter, and financial information in the EMR.
Utilize office systems, software, and technology to track enrollment activity, documentation, and compliance.
Maintain confidentiality and compliance with HIPAA, state, and federal regulations at all times.
Participate in cross-training and coverage as needed to support Patient Access operations.
Perform other duties as assigned.