Eligibility Specialist - Bilingual - 24.04 per hour

TITLE:

Eligibility Specialist
- Bilingual

REPORTS TO:

Eligibility Supervisor

SUPERVISES:
Not Applicable

DEPARTMENT:
Ryan White HIV/AIDS Program

BASED AT:
Access to Healthcare Network
- Reno

STATUS:
Full-Time, Non-Exempt

Access to Healthcare Network (AHN) is a mission-driven nonprofit dedicated to improving access to quality healthcare and supportive services. We foster a collaborative, respectful, and dynamic work environment where team members feel valued and supported. Joining AHN means contributing to meaningful work that positively impacts seniors, individuals with disabilities, and underserved community members.

The Eligibility Specialist supports improved health outcomes for people living with HIV/AIDS by determining eligibility for Ryan White services, helping clients access public and private assistance programs, and identifying payer sources for the AIDS Assistance Program (ADAP). The role involves advocacy, eligibility screening, data entry, documentation, and coordination with clients, agencies, and providers to ensure a seamless continuum of care.

• Conduct eligibility screenings for Ryan White services and verify all required documentation to ensure program compliance.
• Assist clients with completing applications, including enrollment in Liberty Dental and other applicable programs.
• Determine appropriate ADAP payer sources and support clients in accessing medications and treatment to achieve viral suppression.
• Process interim eligibility updates and collect, review, and maintain required documentation.
• Refer clients to case management and other supportive services to ensure comprehensive care.
• Maintain strict confidentiality and professionalism in all interactions, adhering to HIPAA regulations.
• Assist clients with obtaining Employer Insurance Verification Forms (EIVF) and refer eligible individuals to the Health Insurance Program/Cost Sharing Assistance Program (CSAP) for insurance enrollment, premium assistance, tax support, and related services.
• Respond to client and partner communications within 48 hours, ensuring timely and effective service delivery.
• Maintain a strong understanding of payer-of-last-resort requirements to accurately determine ADAP eligibility.
• Follow up with clients, providers, and partner agencies to obtain missing or updated documentation.
• Accurately enter and maintain client data in required database systems within established time frames.

• Build and maintain effective working relationships with AHN providers, clients, community partners, and funding agencies.
• Communicate professionally and effectively with internal staff and external partner organizations.
• Perform general administrative duties to support program operations and service delivery.
• Respond to inquiry calls and provide clear, accurate information regarding Ryan White program requirements and services.
• Maintain working knowledge of AHN services and other healthcare programs, including Medicaid, Medicare, Nevada Check-Up, and the Affordable Care Act.
• Participate in activities and responsibilities associated with state and county grant requirements, ensuring compliance and timely reporting.

• Schedule client appointments, maintain tracking spreadsheets, and monitor ADAP payer sources to support program operations.
• Accurately enter and upload eligibility documentation into database systems in a timely manner.
• Complete pharmacy benefit manager (PBM) data entry for ADAP-related services, ensuring accuracy and compliance.
• Handle protected health information (PHI) in strict accordance with HIPAA regulations and organizational policies.

• Demonstrate working knowledge of Medicaid, Medicare (Parts A &
  
  B), Nevada Check-Up, Affordable Care Act (ACA) plans, and prescription assistance programs.
• Assist clients with navigating health insurance-related costs, including premiums, copayments, deductibles, and access to tax-related assistance programs.

• Demonstrate flexibility in adapting to changing priorities and organizational needs; perform additional duties as assigned.
• Attend required meetings and training sessions while maintaining compliance with all organizational policies, procedures, and standards.

• Bilingual (English and Spanish) – Required
• High school diploma or equivalent; AA Degree preferred
• Minimum of 1 year of experience in healthcare-related social services, case coordination, or patient support
• Minimum of 2 years of experience working with database systems and Microsoft Office applications
• Minimum of 1 year of general office or administrative experience
• Community Health Worker (CHW) Certification (to be obtained within 1 year; agency-funded)
• Exchange Enrollment Facilitator License (to be obtained within 90 days; agency-funded)
• Ability to successfully pass Medicare/Medicaid fraud…