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 ensuringaccurateinsurance verification, confirming program eligibility, andassistingpatients through administrative intake processes.

This role serves as thefront door to the care management program, helpingidentifyeligible 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 ensuresaccuratedocumentation 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 deliveringa professional and compassionate patient experience.

Reports To:

Nursing Manager

Department:

Clinical Operations

• 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 supporttimelyfollow-up.

• Document all patient communications within the care management platform.

• Maintain strict adherence to HIPAA and patient privacy standards during all interactions.

• 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.

• 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.

• Maintainaccuratepatient demographic and insurance information withincaremanagement platform.

• Assist with patient record updates and administrativeworkflowsrelated to care management services.

• Ensure documentation is accurate,complete and compliant with program requirements.

• Support internal teams with patient information verification and administrative tasks.

• Utilize electronic medical records (EMR), care management platforms, and telephony systemsto support patient access workflows.

• Demonstrate strong technicalproficiencywhen navigating multiple healthcare platforms simultaneously.

• Maintainahighlevelofaccuracy when entering patientinformationinto healthcare systems.

• Assist with resolving minor data discrepancies andescalatesystem issues when necessary.

• 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),…