Authorization And Eligibility Specialist

Overview

AUTHORIZATION AND ELIGIBILITY SPECIALIST — OPEN IN-HOUSE THROUGH WEDNESDAY, JULY 15, 2026.

Job Code: 2026-MH-026

Location:

CLINIC (Plummer, ). Carpool opportunities are available.

Preferred Experience:

Some Experience Required

Marimn Health has tribal preference in hiring. A pre-employment drug screening is required.

• Medical, Dental, Prescription, and Vision for employee and all legal dependents.
• 401(k) plan with 10% employer match after 1 year of employment.
• Employer paid life insurance.
• Short and long term disability.
• Generous PTO with the ability to earn additional personal days.

A high school diploma or GED is required. One year of experience in a medical office or healthcare setting is preferred. A minimum of one year of experience working with state, federal or third-party payers is required. This position requires a thorough understanding of multiple services’ benefits within the facility. A minimum of one-year prior experience working with a claims management system, clinical electronic practice management or electronic health record system is required.

Candidates must possess an understanding of all phases of patient eligibility, benefits and prior authorizations process. All applicants must have verifiable, successful records of the following: tenacity, customer service skills, ability to work independently, be detail oriented and patient focused. An understanding of FQHC/Tribal billing requirements is desired.

• Hearing: within normal limits with or without use of corrective hearing devices.
• Vision: adequate to read 12-point type with or without use of corrective lenses.
• Must be able to verbally interact with staff, clients and public.
• Manual dexterity of hands/fingers for writing and data entry.
• Able to lift up to 25 lbs.
• Standing 25-75% of the day.
• Walking 25% of the day.
• Pushing up to 25 lbs.
• Pulling up to 25 lbs.

• Obtain prior authorizations for required services, procedures, devices and pharmaceuticals offered by Marimn Health (including physical therapy services); submit documentation needed.
• Track VA authorization end dates; submit RFS renewals with required chart notes.
• Complete Medicaid Healthy Connections referrals.
• Coordinate with PRC on coverage issues and benefit updates.
• Explain insurance benefits, coverage limitations, and financial responsibilities in a clear, supportive manner.
• Refer patients to Health Insurance Specialist and/or Outreach and Enrollment Specialist for insurance updates or Alternate Resource needs.
• Refer patients to Outreach and Enrollment for Sliding Fee Program applications.
• Process Sliding Fee Applications during Idaho and Washington Open Enrollment period.
• Assist with payment arrangement discussions when appropriate.
• Ensure encounters have accurate payer information to prevent billing errors and denials.
• Collaborate with Revenue to resolve insurance- or authorization-related issues.
• Maintain required reports and tracking tools supporting accurate billing.
• Stay current on payer policy changes, authorization rules, and eligibility requirements.
• Maintain compliance with HIPAA, confidentiality, FQHC/Tribal billing rules, and organizational policies.
• Review daily and upcoming schedules in Epic to ensure insurance information, PCP assignments, and benefits are accurate.
• Resolve Epic Real-Time Eligibility (RTE) errors and complete all items routed to Eligibility Work queues.
• Verify insurance eligibility using payer portals and by phone when required (Dental).
• Document all eligibility and benefit information accurately in Epic; confirm copays, deductibles, coinsurance, out-of-pocket balances, benefit limits, and out-of-network coverage.
• Resolve assigned work queues in Epic daily.
• Participate in required training, meetings, and committees.
• Provide front desk coverage as needed, including patient check-in, answering and directing phone calls, appointment scheduling, and new patient registration.
• Perform other duties as assigned.