Patient Coverage and Support Specialist

OHI - Ocean Health Initiatives, Inc.; Toms River (NJ); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

401(k) Match

Paid Time Off

Paid Holidays

Employee Assistance Program

Employee Discounts

Employee Referral Program

Job summary

OHI - Ocean Health Initiatives, Inc. is seeking a Patient Coverage & Support Specialist to help patients obtain and maintain healthcare coverage through education, outreach, renewal and application assistance, and ongoing follow-up.

The Specialist will manage MCO reports, work with patients, health plans, and internal teams to resolve coverage barriers and prevent gaps in coverage, while supporting registration, outreach events, and enrollment activities in New Jersey.

Qualifications

• High school diploma or equivalent is required.
• Patient centered service; Professional verbal and written communication; ability to explain coverage requirements clearly; strong organization, documentation, follow-up, and worklist management; confidentiality are required.
• Microsoft Office 365 proficiency is required.
• Ability to travel to OHI sites and community outreach locations required.
• Medicaid and insurance literacy; outreach and engagement; registration accuracy; application and document support; consistent follow-up; attention to detail; problem solving and escalation; collaboration and accountability; confidentiality and compliance is required.
• One to three years in patient access, registration, healthcare eligibility, Medicaid enrollment, financial screening, insurance verification, community outreach, or a related healthcare setting are preferred.
• Electronic medical record experience and knowledge of Medicaid renewals, managed care, and public coverage programs are preferred.
• Obtain and maintain the certification and authorization required for assigned enrollment duties, including renewal training and continuing program requirements.

Responsibilities

• Review renewal and redetermination worklists; identify patients approaching deadlines or at risk of losing coverage. Contact patients by telephone and other approved methods, with repeat follow-up as needed.
• Explain Medicaid notices, renewal requirements, deadlines, eligibility processes, and required documents in clear, patient-friendly language.
• Help patients complete Medicaid renewals and eligibility and Presumptive Eligibility applications within required training, certification, and authorization. Schedule and conduct enrollment appointments; assist patients with completing and submitting ACA Marketplace applications, required documentation, and follow-up.
• Help patients gather and submit documents, address incomplete applications and verification requests, and track next steps until resolved, appropriately transferred, or closed under established procedures.
• Explain coverage options without directing patients toward a specific plan unless authorized. Refer or elevate complex issues and assistance outside the role’s scope to the appropriate leader, agency, MCO, or certified resource.
• Review and complete assigned MCO eligibility, renewal, redetermination, termination, and outreach reports within established timeframes. Research each listed patient, conduct outreach, and document the disposition.
• Communicate with MCO representatives about eligibility, discrepancies, renewal concerns, and unresolved cases, consistent with privacy and authorization requirements.
• Maintain organized, accurate, audit-ready records of reports reviewed, contact attempts, patient responses, education, application assistance, documents, barriers, referrals, escalations, and outcomes.
• Keep tracking tools aligned with report status. Enter information in Athenahealth, payer portals, enrollment systems, spreadsheets, Monday.com, and other approved systems as assigned.
• Meet productivity, quality, and outcome expectations; complete required reporting and alert leadership to unresolved cases, coverage risks, recurring barriers, and workflow improvement opportunities.

Skills

Communication

Organization

Attention to detail

Confidentiality

Problem solving

Bilingual English/Spanish (preferred)

Travel readiness

Tools

Microsoft Office 365

Job description

Position Summary

The Patient Coverage & Support Specialist helps patients obtain and maintain healthcare coverage through education, proactive outreach, renewal and application assistance, and ongoing follow-up. The Specialist manages assigned Managed Care Organization (MCO) reports and works with patients, health plans, and internal teams to resolve coverage barriers and prevent avoidable gaps in coverage.

Position Summary

The Patient Coverage & Support Specialist helps patients obtain and maintain healthcare coverage through education, proactive outreach, renewal and application assistance, and ongoing follow-up. The Specialist manages assigned Managed Care Organization (MCO) reports and works with patients, health plans, and internal teams to resolve coverage barriers and prevent avoidable gaps in coverage.
The Specialist maintains basic registration and Patient Liaison skills and supports community education and enrollment events. Registration coverage is provided as needed without allowing primary coverage and MCO responsibilities to fall behind.

Responsibilities

Coverage Retention, Education & Application Support

• Review renewal and redetermination worklists; identify patients approaching deadlines or at risk of losing coverage. Contact patients by telephone and other approved methods, with repeat follow-up as needed.
• Explain Medicaid notices, renewal requirements, deadlines, eligibility processes, and required documents in clear, patient-friendly language.
• Help patients complete Medicaid renewals and eligibility and Presumptive Eligibility applications within required training, certification, and authorization. Schedule and conduct enrollment appointments; assist patients with completing and submitting Affordable Care Act (ACA) Marketplace applications, required documentation, and follow-up.
• Help patients gather and submit documents, address incomplete applications and verification requests, and track next steps until resolved, appropriately transferred, or closed under established procedures.
• Explain coverage options without directing patients toward a specific plan unless authorized. Refer or elevate complex issues and assistance outside the role’s scope to the appropriate leader, agency, MCO, or certified resource.
  

MCO Reports, Documentation & Follow-Up

• Review and complete assigned MCO eligibility, renewal, redetermination, termination, and outreach reports within established timeframes. Research each listed patient, conduct outreach, and document the disposition.
• Communicate with MCO representatives about eligibility, discrepancies, renewal concerns, and unresolved cases, consistent with privacy and authorization requirements.
• Maintain organized, accurate, audit-ready records of reports reviewed, contact attempts, patient responses, education, application assistance, documents, barriers, referrals, escalations, and outcomes.
• Keep tracking tools aligned with report status. Enter information in Athenahealth, payer portals, enrollment systems, spreadsheets, Monday.com, and other approved systems as assigned.
• Meet productivity, quality, and outcome expectations; complete required reporting and alert leadership to unresolved cases, coverage risks, recurring barriers, and workflow improvement opportunities.
  

Registration & Patient Liaison Support

• Maintain competency in registration workflows, systems, policies, and documentation. Provide basic Patient Liaison coverage during high-volume periods or staffing shortages while keeping primary coverage responsibilities current.
• Pre-register, register, and check in patients; verify appointments; and assist with scheduling or rescheduling as assigned.
• Verify coverage through approved tools and update demographics, emergency contacts, insurance, primary care provider information, and required reporting fields in the electronic medical record.
• Collect and accurately file registration forms, consents, and supporting documents. Assist walk-in patients and connect them with financial screening, enrollment, scheduling, or other appropriate services.
  

Community Events & Team Responsibilities

• Support OHI and community outreach, education, enrollment, and patient engagement events
• Provide coverage education, authorized application and document assistance, basic registration, scheduling, and connections to OHI services. Document assistance and complete post-event follow-up.
• Assist with event setup, educational materials, patient flow, and breakdown; protect patient information and documents in all settings.
• Communicate respectfully and professionally with patients, staff, health plans, and community partners. Collaborate with Patient Access, Billing, Practice Management, Outreach, and other departments to address access barriers.
• Follow OHI policies, Corporate Compliance standards, confidentiality requirements, and applicable program rules. Complete required training and meetings and perform other assigned duties supporting operations and the patient experience.
• Complete required training and attend meetings, remain current on approved H.R. 1 and ACA implementation guidance, and perform other assigned duties supporting coverage education, application assistance, and the patient experience.
  

Education, Experience & Qualifications

• High school diploma or equivalent is required.
• Patient centered service; Professional verbal and written communication; ability to explain coverage requirements clearly; strong organization, documentation, follow-up, and worklist management; confidentiality are required.
• Microsoft Office 365 proficiency is required.
• Ability to travel to OHI sites and community outreach locations required.
• Medicaid and insurance literacy; outreach and engagement; registration accuracy; application and document support; consistent follow-up; attention to detail; problem solving and escalation; collaboration and accountability; confidentiality and compliance is required.
• One to three years in patient access, registration, healthcare eligibility, Medicaid enrollment, financial screening, insurance verification, community outreach, or a related healthcare setting are preferred.
• Electronic medical record experience and knowledge of Medicaid renewals, managed care, and public coverage programs are preferred.
• Bilingual English/Spanish preferred.
• Obtain and maintain the certification and authorization required for assigned enrollment duties, including renewal training and continuing program requirements.
• Complete required training and certification before independently providing assistance requiring authorization.
  

Benefits

• Medical, Dental, Vision and Life Insurance
• Flexible Spending Accounts with Medical and Dependent Care
• Voluntary Life Insurance
• 401(k) Salary Deferral and Match
• Paid Time Off
• Paid Holidays
• Employee Assistance Program
• Employee Discounts
• Employee Referral Program