Insurance Verification Specialist

Santa Cruz Community Health• Santa Cruz, CA, US, CA

13d•$23 - $26•Onsite

About The Position

Santa Cruz Community Health (SCCH) is a Federally Qualified Health Center (FQHC) dedicated to improving the health of Santa Cruz County residents. SCCH offers comprehensive health services regardless of a patient's ability to pay, driven by a commitment to healthcare as a human right. The organization is recognized for high-quality, innovative care and engages in advocacy work to empower patients and the community. SCCH provides a diverse patient population and an engaging, friendly work environment where staff collaborate to fulfill the mission of providing quality, whole-person healthcare. The Insurance Verification Specialist is responsible for ensuring accurate and timely insurance verification and program eligibility for all SCCH patients, including screening for eligibility under the Sliding Fee Discount Program (SFDP). This role works collaboratively with billing, front office, and enrollment teams to support clean claim submission, minimize denials, and optimize overall revenue cycle performance. The specialist plays a key role in identifying uninsured and underinsured patients and facilitating access to appropriate coverage and financial assistance programs. This position contributes to a positive patient experience by supporting access to care and aligning with the Patient-Centered Medical Home (PCMH) model. This role requires strong critical thinking, excellent customer service and communication skills, and the ability to manage multiple priorities with a high level of accuracy. Attention to detail, organization, and time management are essential to ensure compliance and operational efficiency.

Requirements

Desire to serve the community clinic population with excellent health care.
High School Diploma or GED.
Previous healthcare experience, including knowledge of HIPAA regulations.
Knowledge of healthcare terminology, procedures, and practice.
Fluent bilingual Spanish/English.
Demonstrated ability to accurately enter, retrieve, and maintain patient information in practice management and EHR systems.
Ability to work some evenings and some Saturdays.
Excellent patient/customer service, communication and follow-through skills.
Knowledge of standard healthcare practice policies and procedures.
Experience working on computers.
Knowledge of Microsoft Office software products.
Ability to work with practice management and EHR systems.
Working knowledge of health insurance plans, eligibility requirements, and associated federal and state assistance programs.
Ability to apply healthcare terminology and standard practice procedures when reviewing patient registration and eligibility information.
Ability to apply HIPAA requirements when accessing, discussing, and documenting patient information.

Nice To Haves

Bachelor’s degree in health or related field.
Knowledge of health insurance plans.

Responsibilities

Utilize insurance portals and payer systems to verify eligibility and benefits for all patients, including commercial insurance, Medicaid, and Medicare.
Complete pre-visit verification of insurance eligibility, benefits, and patient demographic information whenever possible to support clean claim submission and reduce denials.
Identify uninsured or underinsured patients and refer them to appropriate enrollment or eligibility assistance services.
Communicate to patients and/or families regarding payment and insurance requirements prior to appointment.
Document and maintain complete, accurate, and timely insurance and eligibility information in the electronic health record (EHR).
Identify applicable coverage programs and ensure required documentation and forms are completed prior to or at the time of visit.
Serve as Operations’ primary internal resource for insurance verification and pre-registration processes, providing guidance while remaining accountable to the Clinic Manager.
Provide guidance and troubleshooting support to Front Office staff on insurance eligibility, Medi-Cal E-Verification, and other registration-related issues.
Guide Front Office staff in resolving complex insurance verification issues and determining when escalation to Billing is necessary.
Maintain current knowledge of insurance plans, eligibility requirements, and verification processes.
Provide ongoing training and coaching to Front Office staff to strengthen insurance verification and pre-registration skills.
Identify recurring insurance and registration issues and partner with Operations and other departments to improve workflows and consistency.
Screen patients for eligibility under the Sliding Fee Discount Program (SFDP) in accordance with FQHC guidelines.
Collect, review, and document required income and household information accurately and confidentially.
Ensure all SFDP documentation is complete, current, and compliant with organizational and regulatory requirements.
Educate patients on sliding fee eligibility, required documentation, and program guidelines.
Communicate clearly and respectfully with patients and/or families regarding insurance coverage, eligibility status, and payment expectations.
Provide guidance on required documentation and assist patients in understanding available financial assistance programs.
Address patient questions related to benefits, coverage limitations, and out-of-pocket responsibilities.
Maintain professionalism and confidentiality when discussing sensitive financial and personal information.
Collaborate with billing, front office, and enrollment teams to resolve eligibility issues and prevent claim denials.
Support efficient revenue cycle operations through proactive verification and issue resolution.
Assist operational staff with special projects and workflow improvements related to patient access, eligibility, and verification processes.
Participate in the design, implementation, and continuous improvement of workflows, including pre-visit verification processes.
Ensure all insurance, financial, and eligibility-related documentation is scanned and entered the EHR accurately and in a timely manner.
Maintain compliance with all federal, state, and organizational requirements, including FQHC documentation standards and audit readiness expectations.
Protect individually identifiable health information in accordance with HIPAA regulations and organizational policies.
Adhere to established workflows, procedures, and documentation standards.
Participate in quality improvement initiatives related to eligibility verification and patient access processes.
Attend required meetings, training, and organizational committees.
Work collaboratively with cross-functional teams to support patient access and operational efficiency.
Communicate clearly, professionally, and respectfully with colleagues and leadership, and use established channels to raise questions or concerns.
Demonstrate accountability, reliability, and adaptability in a dynamic healthcare environment.
Contribute practical recommendations during team discussions and support implementation of agreed-upon solutions.