Care Access Navigator – Insurance & Eligibility

Trillium Health; City of Rochester (NY); Sur place; USD 42 000 - 60 000; Plein temps

Résumé du poste

Trillium Health in Rochester, NY is hiring an Enrollment & Eligibility Specialist I to handle patient insurance verification, enroll patients in assistance programs, apply sliding fee scales, and support uninsured patients in navigating Medicaid, Medicare, and NY State Marketplace options. The role includes collaboration across departments to reduce out-of-pocket costs in a clinical setting.

Responsibilities include documenting in the EMR, coordinating with front office, and educating patients

Qualifications

• Knowledge of sliding fee scales.
• Knowledge of insurance processes, including prior authorizations.
• Ability to manage multiple tasks throughout the workday.
• Proficiency in Microsoft Office and computerized systems for data entry and reporting.
• Proficiency with electronic medical record systems.
• Excellent organizational, communication, and interpersonal skills.
• Strong listening skills and ability to give and receive constructive feedback.
• Ability to function autonomously and collaboratively as part of a multidisciplinary team.

Responsabilités

• Perform insurance verification checks at least seven (7) days prior to patient appointments to maintain compliance with organizational financial clearance guidelines.
• Ensure primary and secondary insurance designations are accurately represented within the electronic health record.
• Contact patients when insurance verification results in an invalid status and establish a strategy for addressing coverage gaps, including referrals to services and coordinating appointment rescheduling as needed.
• Ensure patient demographic information is maintained and updated.
• Assess patient eligibility for Medicaid, Medicare, and private insurance available through the New York State Marketplace and assist patients with applications.
• Assist patients in applying for insurance assistance during ACA Open Enrollment.
• Complete the "Know Your Coverage" scorecard and educate patients regarding coverage information.
• Follow all established policies and processes related to uninsured patients.
• Collaborate with the Manager, Enrollment & Eligibility regarding policy implementation and compliance.
• Communicate directly with patients who submit billing and reimbursement questions through the patient portal.
• Collaborate with Front Office teams to coordinate enrollment and eligibility follow-up activities as needed.
• Requires ability to respect and support patients, other employees, and visitors with various lived experiences.
• Requires commitment to the mission, vision, One Trillium values, behaviors, and modeling them.
• Responsible for maintaining confidentiality of all patient, client, employee, protected, and proprietary information.
• Participate in compliance audits and quality improvement plans.
• Other duties as assigned.

Connaissances

Insurance verification

Sliding Fee Scale knowledge

Multitasking

Microsoft Office

EMR systems

Communication skills

Team collaboration

Active listening

Formation

Associate’s or Bachelor’s degree preferred

High school diploma or equivalent required

New York State Insurance Assister certification (preferred)

Outils

MS Office

Electronic Medical Records (EMR)

Description du poste

Trillium Health in Rochester, NY is hiring an Enrollment & Eligibility Specialist I to handle patient insurance verification, enroll patients in assistance programs, apply sliding fee scales, and support uninsured patients in navigating Medicaid, Medicare, and NY State Marketplace options. The role includes collaboration across departments to reduce out-of-pocket costs in a clinical setting.

Responsibilities include documenting in the EMR, coordinating with front office, and educating patients