Eligibility Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Eligibility Specialist based in United States.

The Eligibility Specialist plays a key role in helping patients access specialized healthcare services by ensuring eligibility requirements are accurately reviewed and completed. This position supports a seamless patient journey by managing medical documentation, verifying records, and coordinating communication between patients and healthcare teams. The role requires strong attention to detail, empathy, and the ability to navigate sensitive health information with professionalism. Working remotely, the specialist will collaborate with clinical and administrative teams in a fast-paced, patient-focused environment. This is an opportunity to contribute directly to improving healthcare access while supporting high-quality, efficient care delivery. The ideal candidate is organized, proactive, and passionate about creating a positive experience for every patient.

Accountabilities:: The Eligibility Specialist is responsible for managing the patient eligibility process from documentation review through communication and follow-up. The role requires accuracy, confidentiality, and strong coordination skills to ensure patients can successfully begin their care journey.

Review patient records, clinical documentation, and administrative information to determine eligibility accurately and efficiently.

Request, collect, organize, and track medical records from external healthcare providers while maintaining compliance with privacy and confidentiality standards.

Communicate clearly and professionally with patients, clinicians, and external providers throughout the eligibility process.

Keep patients informed about eligibility status, required documentation, and next steps to support a smooth onboarding experience.

Maintain accurate records within electronic medical record (EMR) systems and ensure all required information is complete.

Manage multiple eligibility cases simultaneously while prioritizing tasks and meeting operational expectations.

Apply knowledge of healthcare processes, insurance requirements, and patient support workflows to resolve documentation challenges.

Collaborate independently and with cross-functional teams to improve patient access and operational efficiency.

Requirements:

The ideal candidate brings experience in healthcare administration, medical record review, or patient support environments, with strong organizational abilities and a commitment to accuracy and patient care.

Active Medical Assistant Certification (CMA, RMA, or CCMA) required.

Minimum of 1 year of experience reviewing and collecting medical records or working in a healthcare-related administrative role.

At least 1 year of experience in a primary care, endocrinology, urgent care, or similar clinical setting.

Experience with electronic medical record (EMR) systems and healthcare documentation processes.

Working knowledge of HIPAA regulations and healthcare privacy standards.

Strong written and verbal communication skills with the ability to interact professionally with patients, providers, and internal teams.

Excellent organizational skills and attention to detail, with the ability to manage multiple priorities.

Ability to work independently in a remote environment while collaborating effectively with colleagues.

Previous experience in remote healthcare operations or work-from-home settings is preferred.

Availability to work Monday through Friday, 8:00 AM–4:00 PM EST.

Benefits:

Competitive salary range of $44,000 - $52,000 USD annually .

Equity opportunities within a high-growth healthcare organization.

Comprehensive health benefits, including medical, dental, and vision coverage.

401(k) retirement program.

Flexible work schedules and paid time off.

Paid parental leave.

Fully remote work environment with the ability to work from anywhere in the United States.

Opportunity to contribute to innovative healthcare solutions focused on improving patient outcomes.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1