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 ensuring accurate insurance verification, confirming program eligibility, and assisting patients through administrative intake processes.
This role serves as the front door to the care management program, helping identify eligible 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 ensures accurate documentation 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 delivering a professional and compassionate patient experience.
Reports To: Nursing Manager
Department: Clinical Operations
Job Description:
Patient Call Management & Communication
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 support timely follow-up.
Document all patient communications within the care management platform.
Maintain strict adherence to HIPAA and patient privacy standards during all interactions.
Insurance Verification & Eligibility Determination
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.
Enrollment Pipeline Support
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.
Administrative & Platform Support
Maintain accurate patient demographic and insurance information within care management platform.
Assist with patient record updates and administrative workflows related to care management services.
Ensure documentation is accurate, complete and compliant with program requirements.
Support internal teams with patient information verification and administrative tasks.
Technology & Data Accuracy
Utilize electronic medical records (EMR), care management platforms, and telephony systems to support patient access workflows.
Demonstrate strong technical proficiency when navigating multiple healthcare platforms simultaneously.
Maintain a high level of accuracy when entering patient information into healthcare systems.
Assist with resolving minor data discrepancies and escalate system issues when necessary.
Qualifications and Skills Required:
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), Remote Patient Monitoring (RPM), or population health programs preferred
Experience working with electronic medical record (EMR) systems
Strong technical proficiency and ability to learn new healthcare platforms quickly
Experience handling patient phone calls in a professional healthcare environment
Excellent verbal communication and patient engagement skills
Strong organizational and time management abilities
High attention to detail and documentation accuracy
Competencies:
Competency | Definition |
Patient Communication | Provides clear, compassionate communication when assisting patients. |
Insurance Verification | Demonstrates strong understanding of insurance coverage and eligibility processes. |
Technical Acumen | Navigates EMR systems and healthcare technology platforms efficiently. |
Attention to Detail. | Ensures accuracy in documentation and patient data entry. |
Compliance Awareness | Maintains HIPAA compliance and proper handling of protected health information. |
Organization | Manages multiple tasks and systems effectively in a fast-paced environment. |
Collaboration | Works closely with Enrollment Specialists, Care Coordinators, and operations staff. |
Key Performance Indicators (KPIs)
Insurance verification accuracy rate
Eligibility verification turnaround time
Patient call response quality and timeliness
Voicemail response and routing accuracy.
Work Location, Shift & Schedule
This position is remote (please see remote requirements below). Shifox/Alopex employees work Monday-Friday r according to the business hours of client practices.
Remote Position Requirements:
Reliable and stable Internet – all programs used by Patient Access & Eligibility Specialist are internet based. A quiet and professional work environment suitable for speaking with patients about sensitive information and Protected Health Information (PHI), free of distractions.
Compensation:
Contractors are paid on a monthly basis, see below.
Rate $17.00-$18.00 per hour