Enrollment & Eligibility Specialist I

TRILLIUM HEALTH•Rochester, NY

About The Position

The Enrollment & Eligibility Specialist I works in the Finance Department and is responsible for patient insurance verification to support appropriate insurer payment and help reduce patients’ out-of-pocket expenses for clinical services, including PrEP and sexual health services. The role assesses and enrolls patients in eligible assistance programs, interprets and applies sliding fee scales, maintains accurate electronic medical record documentation, advises on policies and procedures concerning uninsured patients, and collaborates across departments. The specialist verifies insurance before appointments, helps patients address coverage gaps, assesses eligibility for public and private insurance, and assists with applications and coverage education. The role also explains sliding fee scale eligibility and applications, responds to billing and reimbursement questions through the patient portal, and supports enrollment and eligibility follow-up with Front Office teams. Employees are expected to maintain confidentiality, participate in compliance audits and quality improvement, and demonstrate respect for patients, coworkers, and visitors while supporting Trillium Health’s mission and values.

Requirements

High school diploma or equivalent required.
At least three years of experience in a human services or medically based setting.
Knowledge of sliding fee scales.
Knowledge of insurance processes, including prior authorizations.
Ability to manage multiple tasks effectively throughout the workday.
Proficiency in Microsoft Office and computerized systems for data entry and reporting.
Proficiency with electronic medical record systems.
Excellent organizational, written and verbal communication, and interpersonal skills.
Strong listening skills and ability to give and receive constructive feedback.
Ability to work autonomously and collaboratively as part of a multidisciplinary team.

Nice To Haves

Associate’s or bachelor’s degree preferred.
New York State Insurance Assister certification with at least one year of experience as a certified Insurance Assister preferred.

Responsibilities

Perform insurance verification checks at least seven days before patient appointments in accordance with organizational financial clearance guidelines.
Ensure primary and secondary insurance designations are accurately recorded in the electronic health record.
Contact patients when verification shows invalid insurance status and develop a strategy to address coverage gaps, including referrals and appointment rescheduling when needed.
Maintain and update patient demographic information.
Assess patient eligibility for Medicaid, Medicare, and private insurance available through the New York State Marketplace, and assist with applications.
Assist patients with insurance assistance applications during ACA Open Enrollment.
Complete the “Know Your Coverage” scorecard and educate patients about coverage information.
Interpret and apply the FQHC Sliding Fee Scale and the Ryan White Sliding Fee Scale.
Ensure sliding fee scale documentation is accurately and consistently captured in the electronic medical record.
Educate patients and prospective patients about sliding fee scale eligibility and applications.
Follow established policies and processes related to uninsured patients.
Collaborate with the Manager, Enrollment & Eligibility on policy implementation and compliance.
Respond directly to patient portal questions about billing and reimbursement.
Collaborate with Front Office teams on enrollment and eligibility follow-up activities as needed.
Maintain confidentiality of patient, client, employee, protected, and proprietary information.
Participate in compliance audits and quality improvement plans as requested.
Participate in continuous improvement of job responsibilities and organizational or work processes.
Perform other duties as assigned.
Respect and support patients, employees, and visitors with various lived experiences, and demonstrate commitment to the organization’s mission, vision, values, and behaviors.