Enrollment & Eligibility Specialist I

TRILLIUM HEALTH INC•Rochester, NY

11d

About The Position

Join us and be a part of Trillium—a mission‑driven team committed to expanding access to high‑quality, compassionate care for everyone we serve. As an Enrollment & Eligibility Specialist I, you play a key role in ensuring patients receive the coverage, financial assistance, and support they need. You’ll help patients navigate insurance, identify available programs, and connect them with resources that reduce barriers to care, all while collaborating closely across departments to support a seamless patient experience.

Requirements

Minimum 2 years of healthcare enrollment, eligibility, registration, or revenue cycle experience
Hands‑on experience with insurance verification, payer eligibility systems, and EHR/registration platforms
Experience in a hospital, academic medical center, or large multi‑site healthcare organization
Working knowledge of Medicare, Medicaid, and commercial insurance
Proficiency with Microsoft Office and healthcare information systems
Strong attention to detail and ability to manage high‑volume workflows
Strong multitasking and prioritization skills.
Strong organizational, written, and verbal communication skills.
Effective team player with the ability to give and receive feedback.
Works well independently and as part of a multidisciplinary team.

Nice To Haves

Bachelor’s degree in Health Administration, Business, Healthcare Management, or related field preferred

Responsibilities

Complete insurance verification checks at least three days before patient appointments to ensure compliance with Ryan White legislation and related guidelines.
Confirm that primary and secondary insurance information is accurately recorded in the electronic health record.
Contact patients when insurance appears invalid and assist in creating a plan to resolve coverage gaps, which may include referrals or rescheduling appointments.
Maintain accurate and up‑to‑date patient demographic information.
Assess and assist patients with Medicaid, Medicare, and ACA marketplace eligibility and applications.
Provide insurance guidance during ACA open enrollment or qualifying life events.
Complete the “Know Your Coverage” scorecard and educate patients about their benefits.
Monitor patient progress toward their Ryan White Cap on Charges.
Adjust caps in collaboration with Billing and ensure consistent documentation in the EHR.
Educate patients and coordinate with Ryan White Case Managers regarding updates or additional medical bill documentation.
Assign new patients to appropriate specialty providers or facilities based on clinical direction.
Complete and document required prior authorizations, pre‑certifications, and referrals across HMO, PPO, and POS plans.
Record all referral details in the electronic medical record.
Coordinate scheduling or rescheduling communications with patients and specialty providers.
Interpret and apply the FQHC and Ryan White Sliding Fee Scales accurately.
Ensure documentation of sliding fee eligibility is consistently captured in the EHR.
Educate patients and prospective patients on sliding fee scale options.
Respond to patient billing and reimbursement inquiries submitted through MyChart.
Partner with Front Office teams to ensure timely and accurate enrollment and eligibility follow‑up.
Demonstrate an ongoing commitment to inclusiveness, diversity, and the One Trillium values.
Maintain confidentiality of all patient, employee, and proprietary information.
Meet departmental performance standards and participate in audits, compliance reviews, and quality improvement efforts.
Perform additional duties as assigned.