Insurance Enrollment & Verification Specialist

Care Alliance•Cleveland, OH

10d•Onsite

About The Position

Care Alliance Health Center is seeking an Insurance Enrollment & Verification Specialist to support patients with insurance verification, enrollment, and coverage maintenance. This role is crucial in helping patients understand and maintain their healthcare coverage, assisting with Medicaid renewals and other enrollment needs, and identifying coverage issues before they become barriers to care. The specialist will also ensure accurate insurance information and help prevent registration-related claim denials, ultimately contributing to a positive, respectful, and patient-centered healthcare experience.

Requirements

High school diploma or GED required.
At least two years of experience in insurance verification, patient access, Medicaid or Marketplace enrollment, revenue cycle, financial counseling, healthcare registration, or a related role.
Working knowledge of health insurance eligibility, benefits, managed care, patient responsibility, and coordination of benefits.
Ability to interpret insurance and payer information and explain requirements to patients in clear, understandable language.
Strong attention to detail, organization, communication, and follow-through.
Comfortable working with electronic health records, payer portals, web-based systems, and Microsoft Office applications.
Ability to complete required enrollment-assister certifications and annual training.

Nice To Haves

Associate degree in Healthcare Administration, Human Services, Business, Medical Billing, or a related field.
Experience in an FQHC, safety-net healthcare organization, health plan, hospital, county eligibility office, or community enrollment program.
Experience with Epic, preferably OCHIN Epic.
Experience with Ohio Medicaid, Marketplace, and payer eligibility systems.
Current Certified Application Counselor (CAC) or comparable enrollment-assister certification.
Bilingual or multilingual skills that reflect the communities we serve.

Responsibilities

Verify patient insurance eligibility, benefits, and coverage prior to scheduled services.
Identify and resolve insurance discrepancies and coverage issues.
Contact patients regarding expiring, inactive, terminated, or unverified insurance and provide clear next steps.
Maintain accurate insurance, eligibility, and guarantor information within the electronic health record.
Identify registration and eligibility issues that could result in claim denials, delayed reimbursement, or unnecessary patient balances.
Identify patients approaching Medicaid renewal and proactively assist with redetermination requirements.
Conduct outreach to patients regarding renewal deadlines and required documentation.
Assist uninsured and underinsured patients with Medicaid, Medicare, Marketplace, and other eligible coverage applications and renewals.
Identify patients at risk of losing coverage and help address barriers before coverage lapses.
Review self-pay patients for potential insurance eligibility and connect them with appropriate coverage options.
Refer uninsured patients for Sliding Fee Discount Program screening when appropriate.
Help patients understand coverage requirements, renewal deadlines, documentation needs, and available insurance resources.
Assist patients with navigating insurance and enrollment processes.
Provide respectful, patient-centered support to individuals from diverse backgrounds and circumstances.
Connect patients with appropriate enrollment resources and alternative coverage options when needed.