Eligibility Specialist

Eligibility Specialist

Lifeline Connections is a community-based behavioral health organization that specializes in providing confidential and compassionate care to individuals who experience substance use and/or mental health conditions.

Our Vision - As the premier provider of substance use and mental health services in the Pacific Northwest, we are respected and the most trusted resource for behavioral health treatment and whole-person care. We provide a comprehensive continuum of coordinated quality services, foster enduring relationships, and empower our communities to truly thrive.

Our Mission - Through superior customer service, high quality programs, and well-trained and dedicated staff, we inspire hope and support lifesaving changes for people affected by substance use and mental health conditions.

Major Duties:

The Eligibility Specialist is responsible for ensuring accurate and timely verification of patient insurance coverage to support effective billing and revenue cycle operations. This role requires strong analytical thinking, attention to detail, and the ability to proactively identify and resolve eligibility issues. The Eligibility Specialist partners with internal teams, patients, and payers to ensure coverage is verified, documented, and aligned with billing requirements.

This position does not provide clinical services.

Core Competencies & Responsibilities:

1. Insurance Verification & Revenue Integrity

• Accurately verifies and updates patient insurance eligibility and benefits using payer portals, phone, and other verification tools
• Interprets insurance plans, coverage limitations, and authorization requirements to ensure claims are billable
• Maintains accurate and complete patient demographic and insurance records to support clean claim submission
• Identifies discrepancies and proactively resolves issues that may delay or impact reimbursement

2. Analytical Thinking & Problem Solving

• Applies critical thinking to analyze complex insurance coverage details and resolve eligibility-related issues
• Troubleshoots payer-related challenges and escalates appropriately when barriers cannot be resolved independently
• Identifies patterns or recurring issues and communicates trends to leadership

3. Communication & Collaboration

• Communicates clearly and professionally with patients, clinical staff, administrative teams, and insurance representatives
• Partners with clinical and administrative teams to support authorization and pre-authorization processes
• Provides timely updates and ensures alignment across teams regarding eligibility and coverage issues

4. Productivity & Time Management

• Effectively manages work queues and prioritizes tasks to meet productivity expectations and deadlines
• Completes follow-up activities (calls, portal updates, correspondence) in a timely and organized manner
• Demonstrates accountability for maintaining workflow efficiency and minimizing delays

5. Compliance & Documentation Integrity

• Maintains strict confidentiality and adheres to HIPAA and 42 CFR Part 2 regulations
• Ensures all activities are documented accurately and in accordance with organizational policies
• Stays current on payer requirements, regulatory updates, and internal procedures

6. Professionalism & Team Contribution

• Demonstrates reliability, accountability, and consistent attendance
• Builds and maintains effective working relationships across departments
• Supports team and organizational goals, including participation in process improvements and special projects

Qualifications & Skills:

• Experience in insurance verification, medical billing, or revenue cycle operations preferred
• Medical Billing and Coding certification or related education preferred
• Experience with electronic health records (CareLogic preferred)
• Proficiency in Microsoft Excel (sorting, filtering, basic analysis; advanced skills preferred)

Key Competencies:

• Strong attention to detail and accuracy
• Effective verbal and written communication skills
• Ability to work independently and manage multiple priorities
• Strong organizational and time management skills
• Customer service orientation
• Analytical and problem-solving ability

Guidelines:

Work is performed in accordance with Lifeline Connections policies and procedures, Washington Administrative Codes, and all applicable federal and state regulations governing patient confidentiality and billing practices.

Work Environment & Physical Demands:

• Work is performed primarily in an office setting
• Requires prolonged sitting, use of computers, and communication via phone and electronic systems
• Participation in meetings, trainings, and staff development activities may be required

Position Impact:

This role directly impacts revenue cycle performance by ensuring eligibility accuracy, reducing claim denials, and supporting timely reimbursement. Success in this position contributes to the organization's financial health and ability to serve the community.

Salary: $19.00 - 22.00/hr DOE

The Benefits:

Lifeline Connections strives to be an employer of choice by offering regular and full-time employees a robust and highly competitive benefits package designed to support both personal and family well-being. Our comprehensive benefits include multiple options for medical, dental, and vision coverage for employees and their eligible dependents.

In addition, Lifeline Connections provides employer-paid Short Term Disability, Long Term Disability, and Life Insurance, along with access to supplemental coverage options. Full-time employees and eligible part-time employees may also enroll in our 401(k) retirement plan, helping support long-term financial wellness.

Beyond benefits coverage, Lifeline Connections is proud to offer generous paid time off. Both full-time and part-time employees earn PTO at competitive accrual rates that increase with years of service, allowing for meaningful time away from work. Employees also receive paid holidays and personal holidays, reinforcing our commitment to work-life balance and employee well-being.