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 ensuringaccurateinsurance verification, confirming program eligibility, andassistingpatients through administrative intake processes.

This role serves as thefront door to the care management program, helpingidentifyeligible 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 ensuresaccuratedocumentation within electronic medical record (EMR) systems and care management platforms.

The ideal candidate has strong technicalproficiency, excellent communication skills, and the ability to navigate multiple healthcare systems efficiently while deliveringa professionaland compassionate patient experience.

Reports To: Nursing Manager

Department: Clinical Operations

Job Description

Patient Call Management & Communication

• Answer incoming patient calls and provide professional, courteousassistance.

• Respond to patient inquiries related to care management programs and services.

• Manage voicemail systems by reviewing incoming messages and ensuring calls are routed to theappropriate teammember 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 supporttimelyfollow-up.

• Document all patient communications within the care management platform.

• Maintain strict adherence to HIPAA and patient privacy standards during all 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.

• Identifypatients who qualify for enrollment in care management programs.

• Document eligibility verification results in theappropriate 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 outreach and enrollment.

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

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

• Assistwith administrative preparation for patient enrollment processes.

Administrative &PlatformSupport

• Maintainaccuratepatient demographic and insurance information withincaremanagement platform.

• Assistwith patient record updates and administrativeworkflowsrelated to care management services.

• Ensure documentation isaccurate,completeand 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 systemsto supportpatient access workflows.

• Demonstrate strong technicalproficiencywhen navigating multiple healthcare platforms simultaneously.

• Maintainahighlevelofaccuracy when entering patientinformationinto healthcare systems.

• Assistwith resolving minor data discrepancies andescalatesystem issueswhen necessary.

Qualificationsand Skills Required:

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

• Experience verifyinghealth insurance eligibility and benefits

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

• Experience working withelectronic medical record (EMR) systems

• Strong technicalproficiencyand ability to learn new healthcare platforms quickly

• Experience handlingpatient 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:

• Patient Communication: Provides clear, compassionate communication whenassistingpatients.
• Insurance Verification: Demonstratesstrongunderstanding of insurance coverage and eligibility processes.
• Technical Acumen: Navigates EMR systems and healthcare technology platforms efficiently.
• Attention to Detail.: Ensuresaccuracy 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 withEnrollment Specialists, Care Coordinators, and operations staff.

Key Performance Indicators (KPIs)

• Insurance verification accuracy rate

• 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/Alopexemployees work Monday-Friday r according to the business hours of client practices.

Remote Position Requirements:

Reliable and stable Internet – all 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.

Rate$15.00-$17.00 per hour