Patient Eligibility Specialist and Navigator

WACBD - Washington Center for Bleeding Disorders•Seattle, WA

About The Position

The Patient Account Eligibility Specialist and Navigator plays a key role in ensuring patients with bleeding disorders have seamless access to care, treatment, and financial resources. This position proactively supports patients by establishing, verifying and maintaining insurance eligibility, guiding them through the financial aspects of care, and connecting them with available assistance programs. Working collaboratively with clinical staff, pharmacy, billing teams, and external payers, the Specialist helps patients and families understand coverage, benefits, and billing while resolving eligibility and billing concerns with compassion and efficiency. This role also develops knowledge of the local community’s resources and culture to better understand patient needs, enhance the overall patient experience, and positively impact health outcomes.

Requirements

High school diploma or equivalent required; associate or bachelor's degree in healthcare administration, social work, or related field preferred.
At least 3 years of experience in a healthcare setting, preferably in billing, insurance coordination, or patient navigation.
Knowledge of insurance processes, including Medicaid, Medicare, and commercial payers.
Strong interpersonal, communication, and problem-solving skills.
Ability to handle sensitive conversations with empathy and professionalism.
Ability to translate complex insurance terminology into language accessible to patients and non-experts
Experience with electronic health records (EHR) (NextGen) and billing software preferred.

Responsibilities

Serve as the primary point of contact for patients with billing and insurance-related questions and medication access issues
Explain insurance benefits, coverage, co-pays, prior authorizations, and out-of-pocket costs to patients in a clear and compassionate manner.
Identify required referrals, authorizations, and coverage limitations for specialty care, pharmacy services, and infusion therapy
Monitor insurance changes and proactively resolve coverage gaps
Maintain accurate insurance and demographic data within electronic health record (EHR), billing, and pharmacy systems
Support billing team responsibilities including claims submissions, payment posting, and other accounts receivable activities including insurance follow-up
Work closely with the billing team to monitor outstanding patient balances and proactively address potential billing issues.
Support coordination between clinical, pharmacy, social work, and finance staff to address coverage barriers
Maintain compliance with payer requirements and organizational policies
Serve as a trusted point of contact for patients experiencing financial or coverage-related stress
Educate patients and families on insurance benefits, cost-sharing responsibilities, and coverage options
Assist patients in enrolling in insurance coverage, including Medicaid, Medicare, ACA marketplace plans, and manufacturer assistance programs
Provide navigation support for bleeding disorder–specific resources, including factor product coverage, specialty pharmacy coordination, and ancillary services
Maintain expert knowledge of and enroll patients in hemophilia-specific financial resources, including manufacturer co-pay programs, foundation grants, and patient assistance programs
Support participation in federal and state programs such as 340B, Medicaid, and other assistance initiatives as applicable
Ensure confidentiality and compliance with HIPAA and other regulatory requirements
Assist with documentation, audits, and reporting related to eligibility and patient assistance programs
Conduct oneself in a professional manner, exhibiting the highest regard for patients and fellow employees.
Understand role and responsibilities.
Comply with all organization policies and procedures.
Continuously seek professional development and keep abreast of hemophilia and bleeding disorder breakthroughs and news.