Insurance Enrollment & Verification Specialist
$36,420,800–$39,520,000 year
On-siteCleveland, Ohio, United States
Job Summary
Verify patient insurance eligibility, benefits, and coverage prior to scheduled services, identifying and resolving discrepancies to prevent claim denials. Contact patients regarding expiring, inactive, or unverified insurance to provide clear next steps and assist with Medicaid renewals and redetermination requirements. Maintain accurate insurance and guarantor information within the electronic health record while helping uninsured patients navigate enrollment for Medicaid, Medicare, and Marketplace plans. Review self-pay patients for potential eligibility and refer them for Sliding Fee Discount Program screening when appropriate. Provide respectful, patient-centered support by explaining coverage requirements, deadlines, and documentation needs to individuals from diverse backgrounds.
Required Qualifications
- High school diploma or GED
- At least two years of experience in insurance verification, patient access, Medicaid or Marketplace enrollment, revenue cycle, financial counseling, healthcare registration, or a related role
- Working knowledge of health insurance eligibility, benefits, managed care, patient responsibility, and coordination of benefits
- Ability to interpret insurance and payer information and explain requirements to patients in clear, understandable language
- Strong attention to detail, organization, communication, and follow-through
- Comfortable working with electronic health records, payer portals, web-based systems, and Microsoft Office applications
- Ability to complete required enrollment-assister certifications and annual training
Desired Qualifications
- Associate degree in Healthcare Administration, Human Services, Business, Medical Billing, or a related field
- Experience in an FQHC, safety-net healthcare organization, health plan, hospital, county eligibility office, or community enrollment program
- Experience with Epic, preferably OCHIN Epic
- Experience with Ohio Medicaid, Marketplace, and payer eligibility systems
- Current Certified Application Counselor (CAC) or comparable enrollment-assister certification
- Bilingual or multilingual skills that reflect the communities we serve
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