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

In addition to role responsibilities, every employee has the following responsibilities as a part of their employment:

• 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 ApplicationCounselor 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