Bilingual Insurance and Billing Specialist

Position Summary The Insurance & Billing Specialist is responsible for supporting patients and internal teams with insurance eligibility, enrollment support, coverage navigation, and billing-related processes. The role focuses on ensuring accurate insurance verification, facilitating enrollment and renewal activities, and assisting with issue resolution related to coverage and claims. This position serves as a key operational resource to improve access to care by helping patients understand and maintain health coverage while supporting timely and accurate billing workflows. The Insurance & Billing Specialist works collaboratively with clinical, front desk, and revenue cycle staff to ensure compliance with payer requirements and organizational policies. Essential Functions Insurance Eligibility & Coverage Support Verify and document patient insurance coverage, benefits, and eligibility in the EMR and payer systems. Assist patients with insurance applications, renewals, and updates through Maryland Health Connection and other applicable platforms. Provide education to patients regarding insurance coverage, required documentation, and next steps in the enrollment process. Support enrollment, plan selection, and coverage changes for Medicaid, MCHP, and other insurance programs. Troubleshoot and escalate complex insurance issues as appropriate. Collaborate with billing and front desk teams to resolve insurance discrepancies impacting claims submission or reimbursement. Review patient accounts to ensure payer information and financial assistance status are accurate and current. Assist with obtaining required authorizations or documentation as needed. Support denial prevention efforts by maintaining accurate insurance and sliding fee data. Sliding Fee Discount Program Administration Administer the Sliding Fee Discount Program in accordance with federal and organizational requirements. Review income and household documentation to determine eligibility and appropriate discount levels. General Duties Ensure timely completion of applications, renewals, and required documentation. Maintain accurate records and ensure discounts are applied correctly in the EMR and billing systems. Educate patients on program requirements, renewal timelines, and documentation expectations. Maintain timely, accurate documentation in the EMR and Maryland Health Connection portal. Ensure all activities comply with payer guidelines, Sliding Fee Discount Program requirements, organizational policies, and applicable federal and state regulations. Safeguard patient information in accordance with HIPAA and organizational privacy. Provide professional, patient-centered customer service in person and telephonically. Work collaboratively with clinical and administrative teams to support patient access and financial workflows. Participate in required trainings and departmental meetings. Perform other duties as assigned to support operational needs. Core Responsibilities And Organizational Expectations Provides courteous, responsive, and service-oriented support to patients, visitors, and colleagues. Promotes a respectful and welcoming environment, communicates clearly, and works collaboratively to support team and organizational goals. Performs all duties in a manner consistent with Park West Health System’s mission, vision, and organizational values, demonstrating a commitment to quality care, respect, and service excellence. Adheres to all applicable federal, state, and local regulations, as well as organizational policies and procedures, including HIPAA, privacy, and security standards. Follows all infection control, workplace safety, and risk management protocols. Participates in quality improvement and performance initiatives as appropriate to the role. Maintains professionalism, reliability, and accountability in attendance, performance, and communication; completes required trainings; participates in staff meetings and organizational initiatives. Performs other duties on an as-needed basis. Qualifications High school diploma or equivalent required; Associate degree in healthcare administration, business, or related field preferred. Must have CAC (Certified Application Counselor) Certification. Minimum two (2) years of experience in healthcare insurance, eligibility, patient financial services, billing, or financial counseling. Working knowledge of Medicaid, Medicare, and commercial insurance plans. Experience using electronic medical records and payer portals. Bilingual in English/Spanish required. Experience in a Federally Qualified Health Center (FQHC) environment. Experience administering a Sliding Fee Discount Program. Employees in this role must obtain and maintain authorization as an Application Counselor through Maryland Health Connection, including completion of all required training and ongoing compliance requirements. Skills Strong understanding of insurance eligibility, enrollment, and financial assistance processes. Knowledge of Sliding Fee Discount Program requirements and documentation standards. Familiarity with medical billing workflows and payer requirements. Excellent attention to detail and organizational skills. Ability to manage multiple priorities and meet deadlines. Strong customer service and communication skills. Ability to problem-solve and navigate complex insurance or financial scenarios. Proficiency in Microsoft Office and EMR systems. Ability to work independently and collaboratively in a fast-paced healthcare environment. #J-18808-Ljbffr