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
Insurance Verification & Eligibility Determination
Enrollment Pipeline Support
Administrative & Platform Support
Technology & Data Accuracy
Qualifications and Skills Required:
1–3 years of experience in healthcare administration, patient access, insurance verification, or care coordination support
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)
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