Enrollment & Eligibility Specialist I
20 days ago
Rochester
Job Description Overview: Join us and be a part of Trillium—a mission‑driven team committed to expanding access to high‑quality, compassionate care for everyone we serve. As an Enrollment & Eligibility Specialist I, you play a key role in ensuring patients receive the coverage, financial assistance, and support they need. You’ll help patients navigate insurance, identify available programs, and connect them with resources that reduce barriers to care, all while collaborating closely across departments to support a seamless patient experience. Key Responsibilities: Patient Insurance Verification Process • Complete insurance verification checks at least three days before patient appointments to ensure compliance with Ryan White legislation and related guidelines., • Confirm that primary and secondary insurance information is accurately recorded in the electronic health record., • Contact patients when insurance appears invalid and assist in creating a plan to resolve coverage gaps, which may include referrals or rescheduling appointments., • Maintain accurate and up‑to‑date patient demographic information., • Assess and assist patients with Medicaid, Medicare, and ACA marketplace eligibility and applications., • Provide insurance guidance during ACA open enrollment or qualifying life events., • Complete the “Know Your Coverage” scorecard and educate patients about their benefits. Ryan White Part C Cap on Charges • Monitor patient progress toward their Ryan White Cap on Charges., • Adjust caps in collaboration with Billing and ensure consistent documentation in the EHR., • Educate patients and coordinate with Ryan White Case Managers regarding updates or additional medical bill documentation. Coordination of Incoming Referrals • Assign new patients to appropriate specialty providers or facilities based on clinical direction., • Complete and document required prior authorizations, pre‑certifications, and referrals across HMO, PPO, and POS plans., • Record all referral details in the electronic medical record., • Coordinate scheduling or rescheduling communications with patients and specialty providers. Sliding Fee Scale • Interpret and apply the FQHC and Ryan White Sliding Fee Scales accurately., • Ensure documentation of sliding fee eligibility is consistently captured in the EHR., • Educate patients and prospective patients on sliding fee scale options. Cross‑Departmental Support & Collaboration • Respond to patient billing and reimbursement inquiries submitted through MyChart., • Partner with Front Office teams to ensure timely and accurate enrollment and eligibility follow‑up. Miscellaneous • Demonstrate an ongoing commitment to inclusiveness, diversity, and the One Trillium values., • Maintain confidentiality of all patient, employee, and proprietary information., • Meet departmental performance standards and participate in audits, compliance reviews, and quality improvement efforts., • Perform additional duties as assigned. Qualifications • Bachelor’s degree in Health Administration, Business, Healthcare Management, or related field preferred, • Minimum 2 years of healthcare enrollment, eligibility, registration, or revenue cycle experience, • Hands‑on experience with insurance verification, payer eligibility systems, and EHR/registration platforms, • Experience in a hospital, academic medical center, or large multi‑site healthcare organization, • Working knowledge of Medicare, Medicaid, and commercial insurance, • Proficiency with Microsoft Office and healthcare information systems, • Strong attention to detail and ability to manage high‑volume workflows Competencies • Strong multitasking and prioritization skills., • Strong organizational, written, and verbal communication skills., • Effective team player with the ability to give and receive feedback., • Works well independently and as part of a multidisciplinary team. Physical Requirements While performing the duties of this role, the employee may need to stand, sit, walk, use hands, reach, talk, and hear. Occasional stooping, bending, and lifting/moving up to 25 lbs. may be required. Vision requirements include close, distance, peripheral, depth perception, and the ability to adjust focus. This job description reflects essential functions under the ADA.