Eligibility Specialist (Midtown)

Avenue 360 is a FQHC that strives to provide high quality and caring service to promote healthy people and communities. Our 360-degree approach addresses medical needs and social and environmental challenges, like housing. Our compassionate care extends to those with and without insurance. We believe income must not determine the level of access to quality health care. Providing comprehensive, high quality, and caring service is the core of what we do, whether medical, hospice care, engaging adult activities, and supportive housing programs. We strive to address the many social determinants of healthy living in Greater Houston. Our Values PACT We take PRIDE in our work. We have a positive ATTITUDE. We are CURIOUS. We are COMMITTED. We are CARING and CUSTOMER-SERVICE oriented. We are a TEAM. We LEARN, GROW, and INNOVATE. Role Overview The Eligibility Specialist plays a critical role in ensuring Avenue 360 Health & Wellness patients receive appropriate access to care, coverage, and financial assistance. This position supports patients by completing admissions, conducting eligibility assessments, verifying insurance and grant funding, and assisting with applications for services. As part of the front‑line administrative team, the Eligibility Specialist contributes to an excellent patient experience, operational accuracy, and compliance with all local, state, and federal requirements. Areas of Accountability This position is directly accountable for the following key areas: Admissions & Eligibility Processing Perform all admissions activities, including intake, eligibility screenings, and reassessments. Ensure appropriate placement within Avenue 360’s continuum of care (medical, dental, behavioral health). Conduct financial assessments and document verification to maintain compliance with applicable regulations. Client Screening & Assessment Screen and evaluate individual and family needs for the purpose of developing or supporting care plans. Identify financial assistance, grant eligibility, or coverage programs that benefit the patient. Insurance & Grant Verification Verify insurance eligibility through field calls, payer portals, and marketplace systems. Confirm grant program eligibility and update related documentation. Application Assistance & Referrals Assist clients in completing applications for insurance programs and other community resources. Make timely, appropriate referrals and conduct follow‑ups to support patient access to services. Information Management & Documentation Update demographics, financial information, and eligibility documents at every visit or upon changes in circumstance. Ensure documentation is timely, accurate, and entered into the EHR and practice management systems. Front Desk & Patient Support Functions Provide back‑up support for front desk operations, including scheduling, greeting patients, answering phones, and collecting payments. Respond to EHR in‑basket messages and complete related work queue tasks. Quality & Compliance Participate in ongoing quality assurance and quality management activities. Maintain confidentiality, regulatory compliance, and adherence to organizational policies. Communicate with clinical and administrative teams to support care coordination. Assist in maintaining efficient patient flow and operational efficiency. Flexibility & Additional Responsibilities Provide cross‑coverage to other clinics as needed. Adapt to changing priorities and assist with tasks outside of routine responsibilities as needed. Perform additional duties or special projects assigned to support organization operations. Understand that the responsibilities listed are not intended to be all‑inclusive and may evolve based on the needs of the clinic. Education, Licensure/Certification High school diploma or GED required. Experience, Skills/Abilities Related Requirements Minimum of 1 year of experience in a healthcare, customer service, or administrative setting. Experience working with patients, clients, or the public in a fast‑paced environment preferred. Strong ability to multitask while maintaining accuracy and attention to detail. Demonstrated competency in communication, problem‑solving, and maintaining professionalism under pressure. Soft skills such as empathy, adaptability, teamwork, and a service‑oriented mindset. Proficiency with electronic health records (EHR) systems, scheduling software, and basic office technology and software. Knowledge of community resources (primary care safety‑net, social services, HIV/AIDS, homelessness, mental health/substance use) helpful. Bilingual proficiency in English and Spanish is preferred to support effective communication with patients, though candidates who are not bilingual are still encouraged to apply. Continuing Education and Training Requirements Participates in all required training and continuing education as outlined by the organization, funding sources, and any applicable licensure requirements. Maintains up‑to‑date knowledge of eligibility guidelines, compliance requirements, and internal policies. #J-18808-Ljbffr Avenue 360