Eligibility and Benefits Specialist Full Time

At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary The Eligibility & Benefits Specialist plays a crucial role in ensuring patients can access the care they need by verifying insurance benefits and eligibility before admission. With precision and attention to detail, this role reviews patient insurance policies to confirm active coverage, identify covered services, and understand financial responsibilities such as deductibles, co-pays, and out-of-pocket maximums.Specialists proactively verify eligibility with insurance companies to prevent claim denials, delays, and costly errors. They also review visit limits, restrictions, benefit caps, and coordinate verification for secondary insurance when applicable. By ensuring every detail is correct on the front end, the Eligibility & Benefits Specialist safeguards revenue integrity, reduces administrative barriers, and supports a smooth patient admission process.This role demands accuracy, strong organizational skills, and a commitment to operational excellence. As a key member of the Central Access and Authorizations Team (CAAT), the Eligibility & Benefits Specialist actively contributes to quality improvement, problem solving, and productivity initiatives within an interdisciplinary model. Essential Functions Serves as key team member of the new Central Access and Authorizations Team (CAAT), focused exclusively on eligibility and benefit verification. Actively works a queue of patient referrals and references multiple sites to conduct E&B checks, Medicare status and entitlement, citizenship status, and any worker's compensation details.Accesses Medicare Common Working files and calculates Medicare daysAccesses other insurance verification portals to determine benefits and eligibility coverageVerifies patient insurance coverage and eligibility for admission services with primary and secondary payorsMay assist in calling hospital (i.e., case management, nursing, etc.) for admissions dates and SNF datesMay assist with the coordination of benefits, including outreach to patient and/or family to obtain and verify benefits informationObtains revocation letters where needed and appropriate to secure proper funding and reimbursementReview return to acute patients / interrupted stay patients prior to admission and apply the interrupted stay rules where applicableReviews and documents benefit details, including deductibles, co-pays, co-insurance, and out-of-pocket maximumsIdentifies coverage limits, restrictions, benefit caps, and authorization requirementsConfirms policy effective dates, termination dates, and coordination of benefits when applicableAccurately enters benefits data into the appropriate systems in a timely mannerCommunicates benefit details and potential patient responsibility to appropriate team membersParticipates in continuing education/ professional development activitiesLearns and develops full knowledge of the CAAT Admission Processes and actively seeks to continuously improve themLearns and has a full understanding of scheduling and pre-register routines in Meditech and any other referral platform utilized by the CAAT team (i.e., Referral Manager)And ad hoc duties as assigned that fall within scope of the CAAT team Knowledge/Skills/Abilities/Expectations Team player, able to communicate and demonstrate a professional image/attitudeExcellent oral and written communication and interpersonal skillsStrong computer skills with both standard and proprietary applicationsData entry with attention to detailConducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standardsCommunicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and othersAdheres to policies and practices of ScionHealthMust read, write, and speak fluent EnglishMust have good and regular attendanceApproximate percent of time required to travel: N/AQualificationsEducation High School Diploma or GED required, Associates or Bachelors Degree preferred;Preference towards a healthcare related area of concentration or be a licensed health care provider or equivalent experience. Licenses/Certifications Certified Benefits Specialist, preferred.In lieu of a healthcare related field certificate, 2+ years of experience performing the functions of the role will be accepted Experience Experience in a healthcare-related area is strongly preferredIdeal candidates will be highly detail oriented, have benefits, medical terminology, revenue cycle management, knowledge of post-acute care industry, and long-term acute care hospital experience.

Created: 2026-04-02