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 ensuring accurate insurance verification, confirming program eligibility, and assisting patients through administrative intake processes.

This role serves as the front door to the care management program, helping identify eligible 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 ensures accurate documentation within electronic medical record (EMR) systems and care management platforms.

The ideal candidate has strong technical proficiency, excellent communication skills, and the ability to navigate multiple healthcare systems efficiently while delivering a professional and compassionate patient experience.

Reports To: Nursing Manager

Department: Clinical Operations

Job Description:

Patient Call Management \& Communication

• Answer incoming patient calls and provide professional, courteous assistance.
• Respond to patient inquiries related to care management programs and services.
• Manage voicemail systems by reviewing incoming messages and ensuring calls are routed to the appropriate team member 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 support timely follow\-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.
• Identify patients who qualify for enrollment in care management programs.
• Document eligibility verification results in the appropriate 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 is accurate.
• Communicate eligibility findings with Enrollment Specialists to support effective patient outreach.
• Assist with administrative preparation for patient enrollment processes.

Administrative \& Platform Support

• Maintain accurate patient demographic and insurance information within care management platform.
• Assist with patient record updates and administrative workflows related to care management services.
• Ensure documentation is accurate, complete and 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 systems to support patient access workflows.
• Demonstrate strong technical proficiency when navigating multiple healthcare platforms simultaneously.
• Maintain a high level of accuracy when entering patient information into healthcare systems.
• Assist with resolving minor data discrepancies and escalate system issues when necessary.

Qualifications and Skills Required:

• 1–3 years of experience in healthcare administration, patient access, insurance verification, or care coordination support
• Experience verifying health insurance eligibility and benefits
• Familiarity with Chronic Care Management (CCM), Remote Patient Monitoring (RPM), or population health programs preferred
• Experience working with electronic medical record (EMR) systems
• Strong technical proficiency and ability to learn new healthcare platforms quickly
• Experience handling patient 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:

Competency

Definition

Patient Communication

Provides clear, compassionate communication when assisting patients.

Insurance Verification

Demonstrates strong understanding of insurance coverage and eligibility processes.

Technical Acumen

Navigates EMR systems and healthcare technology platforms efficiently.

Attention to Detail.

Ensures accuracy 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 with Enrollment 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/Alopex employees 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 $17\.00\-$18\.00 per hour

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