Eligibility Specialist

Position Title: Eligibility Specialist Location: C arolyn Downs Family Medical Center and Country Doctor Community Clinic Expected Hour s: 20 hours/week Union: Yes Salary $23.23– $34.69 Per hour, non-exempt, payable bi-weekly. The salary scale for this position is between steps 0 and 19, depending on experience. We use the resume submitted on your application to determine your hourly wage, so please ensure that all relevant work experience is listed in your resume.

Applicants must pass an extensive background check. About Us Seattle Roots Community Health is a not-for-profit organization that operates two primary care clinics, an After-Hours Clinic, two School-Based Health Centers, a low barrier Medication-assisted treatment clinic and a Dental Clinic. Our Carolyn Downs Family Medical Center was founded in 1970 in Seattle's Central District. Our Country Doctor Community Clinic was established in 1971 by residents of the Capitol Hill neighborhood.

Seattle Roots is passionate about serving patients of all backgrounds and employing individuals who are equally committed to this mission. To ensure our organization is best serving our populations, we strive to promote policies that enable us to work effectively in all situations, with patients, with coworkers, and with the community. Our Mission To improve the health of our community by providing high-quality and caring primary health care that addresses the needs of people, regardless of their ability to pay.

At Carolyn Downs and Country Doctor, healthcare is a right. Job Summary The Eligibility Specialist plays a key role in ensuring that patients have access to the necessary benefits and financial assistance by verifying eligibility for insurance programs, including Medicaid, Medicare, and other public and private health plans. This position involves interacting with patients, insurance providers, and healthcare providers to ensure accurate and up-to-date information is gathered for billing, claims, and treatment planning.

The Eligibility Specialist will also assist patients in navigating insurance options and coordinate with other team members to optimize patient coverage. Job Responsibilities Verify patient eligibility for insurance coverage, including Medicaid, Medicare, and private health plans, in a timely and accurate manner. Assist patients with understanding their insurance benefits and help them navigate the process of obtaining or renewing insurance coverage.

Document eligibility verification results and maintain up-to-date patient records. Communicate with insurance companies and third-party payers to resolve issues related to eligibility. Process and assist patients with applications for financial assistance programs, Medicaid Applications, the Affordable Care Act (ACA), and charity care programs. Collaborate with healthcare providers, social workers, and case managers to identify patients who may be eligible for additional services or financial assistance.

Provide assistance to patients and their families regarding insurance coverage, financial responsibility, and payment options. Monitor and manage eligibility queues to ensure tasks are completed within established timelines. Maintain knowledge of insurance regulations, , and healthcare policies to ensure accurate and efficient eligibility determination. Ensure compliance with all federal, state, and organization-specific regulations.

Qualifications Minimum of 2 years of experience in a healthcare setting, specifically in eligibility verification, patient access, or insurance verification. Knowledge of public and private health insurance programs, including Medicaid, Medicare, and commercial health plans. Strong understanding of healthcare terminology, billing processes, and insurance coverage details. Ability to communicate clearly and effectively with patients, insurance companies, and other stakeholders.

Experience using electronic health record (EHR) systems, including Epic, to manageeligibility and patient data. Ability to maintain a high level of organization and manage multiple tasks simultaneously. Strong problem-solving skills and attention to detail. Proficiency with Microsoft Office applications, especially Outlook, Excel and Word. Excellent customer service skills, with the ability to work effectively with patients and team members.

Education & Training: High School Diploma, GED, or equivalent required. Associate's degree in healthcare administration, business, or a related field preferred. Certification by WA State HCA Health Benefit Exchange, within 30days of employment. Basic Life Support (BLS) and/or CPR certification is a plus Benefits We provide a robust suite of benefits, including the choice of three medical plans, two dental plans, long-term disability, life, and other insurance programs.

You’ll have access to flexible spending accounts, a subsidy of up to 80% of the cost of an ORCA pass, plus an additional match of 50% of the employee's contribution up to 4% after one year of employment. (Ex. if employee contributes at 4%, Seattle Roots will match with an additional 2%, plus the safe harbor contribution totaling a 9% contribution to the employee's 401k) We’ve got you covered!