Eligibility and Insurance Verification Specialist

Position Summary: Supports access to TAN Healthcare behavioral health services, including medication management and counseling, by completing patient registration, insurance verification, financial eligibility screening, and scheduling support during assigned part-time hours. Works with patients, billing staff, front desk staff, and clinical teams to reduce barriers to care, maintain accurate eClinicalWorks records, and support TAN Healthcare’s mission of All Care All People. Essential Job Responsibilities Patient Access and Registration Engage new and established patients by telephone and in person with compassion, professionalism, and respect; explain TAN services and approved intake requirements. Assist patients with registration packets and required administrative forms; accurately enter and update demographics, contact information, insurance information, and supporting documents in eClinicalWorks. Schedule appointments within approved provider templates and workflows; communicate preparation requirements and route clinical scheduling questions to the appropriate team. Assist with patient portal setup and access; arrange approved language assistance and communicate accessibility or other barriers to the appropriate team. Document outreach attempts, unresolved needs, and next steps; provide clear handoffs so patients do not have to repeat or resolve internal coordination issues themselves. Insurance Verification and Financial Eligibility Verify active coverage, effective dates, payer and plan information, provider participation, applicable benefits, copayments, deductibles, and other patient responsibility using approved payer resources. Verify behavioral health benefits separately when administered by a different payer or benefit manager; identify benefits for counseling and medication management, telehealth coverage, visit limits, referral requirements, and authorization requirements. When a PCP assignment change is required, explain the approved process, provide the appropriate information or form, document assistance and status, and communicate unresolved issues before the appointment when possible. Document verification date, source or reference number, findings, and follow-up needs. Reverify coverage when required by TAN workflows or when coverage changes; do not represent verification as a guarantee of payment. Explain the availability of the Sliding Fee Discount Program to insured and uninsured patients. Assess eligibility based on income and family size using TAN’s approved policies and current schedule; obtain and document supporting information and reassessments under approved procedures. Explain approved financial information without independently changing fees, eligibility criteria, or workflows. Escalate missing documentation, disputed determinations, inactive coverage, and inability-to-pay concerns; follow TAN policy so inability to pay does not become a barrier to care. Behavioral Health Coordination Coordinate with behavioral health staff and billing on required referrals, authorizations, approved visit counts, and expiration dates. Track and communicate pending items within the assigned workflow to help prevent interruptions in care; obtain authorizations only when assigned and trained. Support new-patient intake, follow-up scheduling, and outreach for missed appointments under approved workflows, while protecting sensitive information in calls, messages, and records. Use respectful, trauma-informed communication. Immediately route reported safety concerns, urgent symptoms, or crisis statements to designated clinical staff and follow TAN emergency procedures; this role does not provide clinical triage or counseling. Document completed work and hand off pending benefits checks, authorizations, and patient needs before scheduled time off so follow-up continues between part-time shifts. Patient Centered Care and Compliance Support the Patient Centered Medical Home model through timely access, continuity, coordinated communication, and connection to primary care and community resources. For behavioral health patients, coordinate with the primary care team as appropriate under approved privacy and consent procedures. Carry out assigned duties consistent with TAN policies and applicable HRSA Health Center Program requirements, including equitable access, sliding-fee processes, accurate records, and participation in quality improvement. Protect confidential information under HIPAA and other applicable privacy requirements, including additional behavioral health or substance use record protections when applicable. Use approved systems, verify identity and authority before disclosures, and access only information needed for assigned duties. Complete required training; cooperate with audits and record reviews; promptly report errors, privacy concerns, safety issues, and suspected noncompliance through established channels. Demonstrate reliability, collaboration, knowledge, innovation, and compassion. Crosstrain and provide administrative coverage as assigned within training and role boundaries; perform other related duties as assigned. Minimum Education, Qualifications, and Experience High school diploma or GED required. Medical assistant training or certification preferred; this is an administrative position. Prior healthcare experience and/or two years of insurance verification experience preferred. Behavioral health insurance and authorization experience preferred. Demonstrated knowledge of insurance benefits and verification; strong attention to detail, organization, follow-through, and professional oral and written communication. Proficiency with computer navigation, Microsoft Office, payer portals, electronic records, and general office equipment; ability to manage multiple telephone lines and competing priorities. Ability to work effectively with diverse patients, including uninsured and underserved populations. Spanish speaking and writing skills preferred. Meet applicable background screening and post-offer occupational health requirements under TAN policies.