Eligibility Specialist - Bilingual

Accesstohealthcare

Reno (NV)

On-site

USD 42,000 - 60,000

Full time

14 days+

Application generator

Get a reply from this employer — a resume and cover letter tailored to exactly what they’re hiring for.

Get past ATS filters

Benefits offered by this job

Medical Insurance & Vision provided at

Health Savings Account (HSA)

Dependent Care FSA

Dental Insurance

Life Insurance

4 Weeks Paid Time off

WFH Options

Holidays

Bereavement Leave

Paid parental leave

Tuition Assistance

Job summary

Access to Healthcare Network (AHN) in Reno, NV seeks a bilingual Eligibility Specialist to determine Ryan White eligibility, assist clients with applications, and connect them to payer sources and ADAP.

You will coordinate data entry, maintain documentation, support case management, and work with providers and community partners while upholding HIPAA and confidentiality.

Qualifications

Bilingual English and Spanish required.
Minimum of 1 year in healthcare-related social services or patient support.
Experience with database systems and Microsoft Office.
CHW Certification and Enrollment Facilitator License pursued within timelines.
Ability to pass Medicare/Medicaid fraud screening.

Responsibilities

Conduct eligibility screenings for Ryan White services and verify documentation for program compliance.
Assist clients with applications and enrollment in applicable programs.
Determine ADAP payer sources and support access to medications and treatment.
Maintain client data in database systems within established timeframes.
Coordinate with case management and partner agencies to ensure continuum of care.
Maintain HIPAA confidentiality in all interactions.
Respond to inquiries within 48 hours.

Skills

Bilingual (English and Spanish)

Communication skills

Education

High school diploma or equivalent

AA Degree preferred

CHW Certification (within 1 year)

Exchange Enrollment Facilitator License (within 90 days)

Tools

Microsoft Office

Database systems

Job description

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

About Access to Healthcare Network (AHN)

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.

JOB PURPOSE

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.

KEY RESPONSIBILITIES AND ACCOUNTABILITIES

Program & Eligibility Coordination

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 timeframes.

Community & Partner Interaction

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.

Data & System Management

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.

Insurance & Payment Assistance

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.

Adaptability & General Expectations

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.

EDUCATION & EXPERIENCE REQUIRED

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 screening

WORK ENVIRONMENT & PHYSICAL REQUIREMENT

The noise level in the work environment is usually moderate, and the employee usually works in a climate-controlled office environment
Be able to sit at a computer for up to 6 - 8 hours per day
Be able to stand between 3 - 6 hours per day.
Be able to withstand frequent hand/wrist deviation and repetition
Must be able to lift, carry up to 30 pounds with a fair consistency

The statements herein are intended to describe the general nature and level of the position, but are not necessarily a complete list of responsibilities, duties and skills required of employee(s) so classified. As such, responsibilities, duties, and required skills may be changed, expanded, reduced, or deleted to meet the business needs of Access to Healthcare Network. Furthermore, they do not establish a contract or implied contract for employment.

FUNDING CLAUSE

This position is funded through external grant sources. Continued employment is contingent upon the ongoing availability of this funding. If funding is reduced or discontinued, the position may be changed or eliminated.

As an equal opportunity employer, we are committed to identifying and developing the skills and leadership of people from diverse backgrounds.

Benefits