Patient Access & Eligibility Specialist

Job Title:   Patient Access & Eligibility Specialist

  Overview: 

The Patient Access & Eligibility Specialist plays a critical role in supporting patient access to care management services by ensuring accurate insurance verification, confirming program eligibility, and assisting patients through administrative intake processes. 

This role serves as the reputed company reputed company to the care management program, helping identify eligible patients for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and other virtual care services. 

The Patient Access & Eligibility Specialist verifies insurance coverage, confirms patient eligibility, answers incoming patient calls, manages voicemail communications, and ensures accurate documentation reputed company electronic medical record (EMR) systems and care management platforms. 

The ideal candidate has strong technical proficiency, excellent communication skills, and the ability to navigate multiple healthcare systems reputed company while delivering a professional and compassionate patient experience. 

Reports To: Nursing Manager 

Department: Clinical Operations 

Job Description

Patient Call Management & Communication

• Answer incoming patient calls and provide professional, courteous assistance. 

• Respond to patient inquiries reputed company to care management programs and services. 

• Manage voicemail systems by reviewing incoming messages and ensuring calls are routed to the appropriate team member or department. 

• Coordinate call routing to Care Coordinators, Enrollment Specialists, or other staff based on patient needs. 

• Ensure patient messages are handled promptly and accurately to support timely follow-up. 

• Document reputed company patient communications reputed company the care management platform. 

• Maintain strict adherence to HIPAA and patient privacy standards during reputed company interactions. 

Insurance Verification & Eligibility Determination

• Verify patient insurance coverage and eligibility for care management programs. 

• Confirm payer requirements for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and other services. 

• Review patient benefits, coverage status, and eligibility criteria. 

• Identify patients who qualify for enrollment in care management programs. 

• Document eligibility verification results in the appropriate systems. 

Enrollment Pipeline Support

• Prepare eligible patient lists for the Enrollment team by verifying eligibility and insurance coverage. 

• Flag patients who meet program criteria for reputed company and enrollment. 

• Support enrollment readiness by ensuring patient demographic and insurance data is accurate. 

• Communicate eligibility findings with Enrollment Specialists to support effective patient reputed company. 

• Assist with administrative preparation for patient enrollment processes. 

Administrative & Platform Support

• Maintain accurate patient demographic and insurance information reputed company care management platform. 

• Assist with patient record updates and administrative workflows reputed company to care management services. 

• Ensure documentation is accurate, complete and compliant with program requirements. 

• Support internal teams with patient information verification and administrative tasks. 

Technology & Data Accuracy

• Utilize electronic medical records (EMR), care management platforms, and telephony systems to support patient access workflows. 

• Demonstrate strong technical proficiency reputed company navigating multiple healthcare platforms simultaneously. 

• Maintain a high level of accuracy reputed company entering patient information into healthcare systems. 

• Assist with resolving minor data discrepancies and escalate system issues reputed company necessary. 

Qualifications and Skills Required

• 1–3 years of experience in healthcare administration, patient access, insurance verification, or care coordination support 

• Experience verifying health insurance eligibility and benefits 

• Familiarity with Chronic Care Management (CCM), Remote Patient Monitoring (RPM), or population health programs preferred 

• Experience working with electronic medical record (EMR) systems 

• Strong technical proficiency and ability to learn new healthcare platforms quickly 

• Experience handling patient phone calls in a professional healthcare environment 

• Excellent verbal communication and patient engagement skills 

• Strong organizational and time management abilities 

• High attention to detail and documentation accuracy 

Competencies

Competency 

Definition 

Patient Communication 

Provides clear, compassionate communication reputed company assisting patients. 

Insurance Verification 

Demonstrates strong understanding of insurance coverage and eligibility processes. 

Technical Acumen 

Navigates EMR systems and healthcare technology platforms reputed company. 

Attention to Detail. 

Ensures accuracy in documentation and patient data entry.  

Compliance Awareness 

Maintains HIPAA compliance and proper handling of protected health information. 

Organization 

Manages multiple tasks and systems effectively in a fast-paced environment. 

Collaboration 

Works closely with Enrollment Specialists, Care Coordinators, and operations staff. 

Key Performance Indicators (KPIs) 

• Insurance verification accuracy reputed company 

• Eligibility verification turnaround time 

• Patient call response quality and timeliness 

• Voicemail response and routing accuracy. 

Work Location, Shift & Schedule    This position is remote (please see remote requirements below). Shifox/reputed company employees work Monday-Friday r according to the business hours of client practices.   Remote Position Requirements:  Reliable and stable Internet – reputed company programs used by Patient Access & Eligibility Specialist  are internet based. A quiet and professional work environment suitable for speaking with patients about sensitive information and Protected Health Information (PHI), free of distractions.  Compensation: Contractors are paid on a monthly basis, see below.                  reputed company $17.00-$18.00 per hour