Insurance Specialist

Community Council Health Systems; Philadelphia (Philadelphia County); On-site; USD 45,000 - 65,000; Full time

Job summary

Community Council Health Systems (CCHS) is seeking an Insurance Specialist to ensure participants have active coverage and required co-pays are collected. The role involves verifying Medicaid/Medicare, updating records in Credible, and coordinating with internal programs on eligibility changes.

The position emphasizes data accuracy, confidentiality, and timely documentation across multiple payer portals and the EHR system to support billing and service delivery.

Qualifications

• Experience verifying Medicaid/Medicare coverage and eligibility.
• Proficient in EHR data entry and documentation accuracy.
• Familiar with payer portals and Credible documentation workflow.

Responsibilities

• Verify insurance eligibility for Medicaid, Medicare, and commercial plans.
• Document and update insurance information in the EHR system accurately.
• Collaborate with internal programs on eligibility changes and coverage issues.
• Follow up to obtain current insurance cards and required documentation.
• Ensure confidentiality and proper handling of participant data.
• Monitor self-pay accounts and generate enrollment reports as needed.

Skills

Insurance verification

Documentation accuracy

EHR system knowledge

Medicaid/Medicare portals

Privacy & confidentiality

Cross-team collaboration

Tools

Promise portal

270/271 transactions

Credible system

Availity, NaviNet portals

Novitasphere portal

Job description

Benefits Of Working With Us

Working at Community Council Health Systems (CCHS) means being part of a compassionate and mission-driven organization dedicated to empowering individuals and families through mental wellness and community support. We foster an inclusive and collaborative work environment where every team member’s contributions are valued and encouraged. At CCHS, employees have opportunities for professional growth, ongoing learning, and career development. We prioritize work-life balance and offer a comprehensive benefits package, including competitive salaries, health, dental, and vision insurance, retirement plan options, paid time off, and professional development opportunities. By joining our team, you become part of a dynamic organization committed to innovation, integrity, and making a meaningful impact in the communities we serve.

Benefits Of Working With Us

Working at Community Council Health Systems (CCHS) means being part of a compassionate and mission-driven organization dedicated to empowering individuals and families through mental wellness and community support. We foster an inclusive and collaborative work environment where every team member’s contributions are valued and encouraged. At CCHS, employees have opportunities for professional growth, ongoing learning, and career development. We prioritize work-life balance and offer a comprehensive benefits package, including competitive salaries, health, dental, and vision insurance, retirement plan options, paid time off, and professional development opportunities. By joining our team, you become part of a dynamic organization committed to innovation, integrity, and making a meaningful impact in the communities we serve.

General Overview

The Insurance Specialist ensures that all consumers have active insurance coverage, required co-payments are collected, and accurate documentation is maintained in Credible to support billing and service delivery.

Key Responsibilities

Insurance Verification & Documentation

• Perform insurance eligibility and coverage verification for individuals with Medicaid coverage using the Promise portal.
• Process bulk insurance eligibility verification and documentation through 270/271 transactions within the EHR system.
• Verify Medicare eligibility and coverage using the Novitasphere portal.
• Conduct commercial insurance verification through various payer portals, including Availity, NaviNet, and other applicable systems.
• Review insurance verification results and update insurance information within the EHR system accurately and timely.
• Communicate and collaborate with internal programs regarding insurance changes, eligibility updates, and coverage-related issues.
• Follow up with participants and/or internal programs to obtain current physical copies of insurance cards and other required insurance documentation.
• Ensure current insurance cards and supporting documentation are uploaded to and maintained accurately within Credible when insurance information changes.
• Identify individuals who no longer meet insurance eligibility requirements for their respective program and issue appropriate correspondence regarding changes in eligibility or coverage.
• Maintain working knowledge of insurance eligibility requirements and program-specific coverage criteria for CCHS services, including Outpatient, IBHS, Resiliency Center, NFA, CBCM, and MSS.
• Monitor insurance information for accuracy and completeness and identify discrepancies requiring follow-up or resolution.
• Maintain confidentiality and handle participant insurance information in accordance with organizational policies, applicable regulations, and privacy requirements.
• Monitor self-pay accounts and coordinate the collection and resolution of outstanding statement balances in accordance with organizational policies and established procedures.
• Generate, review, and analyze reports to ensure required data is complete, accurate, and available for enrollment processes and MHX reporting requirements.