Enrollment & Eligibility Specialist I

TRILLIUM HEALTH INC•City of Rochester, NY

12h•$20 - $29

About The Position

The Enrollment & Eligibility Specialist I is responsible for patient insurance verification to ensure appropriate insurer payment and help reduce patients’ out-of-pocket expenses for clinical services, including PrEP/Sexual Health services. The specialist evaluates patients for eligible assistance programs, supports applications, interprets and applies sliding fee scales, and ensures accurate documentation in the electronic medical record. The role also advises on policies and procedures for uninsured patients and collaborates with other departments. The position requires respect for patients, employees, and visitors with varied lived experiences, and a commitment to Trillium Health’s mission, vision, values, and behaviors. The employee must maintain confidentiality of patient, client, employee, protected, and proprietary information; meet departmental performance standards; participate in compliance audits and quality improvement plans as requested; and contribute to continuous improvement. Other duties may be assigned.

Requirements

High school diploma or equivalent.
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 throughout the workday.
Proficiency in Microsoft Office and computerized systems used 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.
Ability to respect and support patients, employees, and visitors with varied lived experiences, and to demonstrate commitment to the organization's mission, vision, values, and behaviors.
Ability to maintain confidentiality and meet departmental performance standards.

Nice To Haves

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

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 insurance verification shows invalid coverage and develop a plan to address coverage gaps, including referrals and appointment rescheduling as needed.
Maintain and update patient demographic information.
Assess patient eligibility for Medicaid, Medicare, and private insurance 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 their coverage.
Interpret and apply the FQHC Sliding Fee Scale and Ryan White Sliding Fee Scale.
Ensure sliding fee scale documentation is accurately and consistently recorded 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 billing and reimbursement questions submitted through the patient portal.
Coordinate enrollment and eligibility follow-up activities with Front Office teams as needed.
Maintain confidentiality and participate in compliance audits, quality improvement plans, and continuous improvement activities as required.