Eligibility Specialist - Bilingual

TITLE: Eligibility Specialist - Bilingual

REPORTS TO: Eligibility Supervisor

SUPERVISES: Not Applicable

DEPARTMENT: Ryan White HIV/AIDS Program

BASED AT: Access to Healthcare Network – Reno

STATUS: Full-Time, Non-Exempt

About Access to Healthcare Network (AHN)

Access to Healthcare Network (AHN) is a mission-driven nonprofit dedicated to improving access to quality healthcare and supportive services. We foster a collaborative, respectful, and dynamic work environment where team members feel valued and supported. Joining AHN means contributing to meaningful work that positively impacts seniors, individuals with disabilities, and underserved community members.

JOB PURPOSE

The Eligibility Specialist supports improved health outcomes for people living with HIV/AIDS by determining eligibility for Ryan White services, helping clients access public and private assistance programs, and identifying payer sources for the AIDS Assistance Program (ADAP). The role involves advocacy, eligibility screening, data entry, documentation, and coordination with clients, agencies, and providers to ensure a seamless continuum of care.

KEY RESPONSIBILITIES AND ACCOUNTABILITIES

Program & Eligibility Coordination

• Conduct eligibility screenings for Ryan White services and verify all required documentation to ensure program compliance.
• Assist clients with completing applications, including enrollment in Liberty Dental and other applicable programs.
• Determine appropriate ADAP payer sources and support clients in accessing medications and treatment to achieve viral suppression.
• Process interim eligibility updates and collect, review, and maintain required documentation.
• Refer clients to case management and other supportive services to ensure comprehensive care.
• Maintain strict confidentiality and professionalism in all interactions, adhering to HIPAA regulations.
• Assist clients with obtaining Employer Insurance Verification Forms (EIVF) and refer eligible individuals to the Health Insurance Program/Cost Sharing Assistance Program (CSAP) for insurance enrollment, premium assistance, tax support, and related services.
• Respond to client and partner communications within 48 hours, ensuring timely and effective service delivery.
• Maintain a strong understanding of payer-of-last-resort requirements to accurately determine ADAP eligibility.
• Follow up with clients, providers, and partner agencies to obtain missing or updated documentation.
• Accurately enter and maintain client data in required database systems within established timeframes.

Community & Partner Interaction

• Build and maintain effective working relationships with AHN providers, clients, community partners, and funding agencies.
• Communicate professionally and effectively with internal staff and external partner organizations.
• Perform general administrative duties to support program operations and service delivery.
• Respond to inquiry calls and provide clear, accurate information regarding Ryan White program requirements and services.
• Maintain working knowledge of AHN services and other healthcare programs, including Medicaid, Medicare, Nevada Check-Up, and the Affordable Care Act.
• Participate in activities and responsibilities associated with state and county grant requirements, ensuring compliance and timely reporting.

Data & System Management

• Schedule client appointments, maintain tracking spreadsheets, and monitor ADAP payer sources to support program operations.
• Accurately enter and upload eligibility documentation into database systems in a timely manner.
• Complete pharmacy benefit manager (PBM) data entry for ADAP-related services, ensuring accuracy and compliance.
• Handle protected health information (PHI) in strict accordance with HIPAA regulations and organizational policies.

Insurance & Payment Assistance

• Demonstrate working knowledge of Medicaid, Medicare (Parts A & B), Nevada Check-Up, Affordable Care Act (ACA) plans, and prescription assistance programs.
• Assist clients with navigating health insurance-related costs, including premiums, copayments, deductibles, and access to tax-related assistance programs.

Adaptability & General Expectations

• Demonstrate flexibility in adapting to changing priorities and organizational needs; perform additional duties as assigned.
• Attend required meetings and training sessions while maintaining compliance with all organizational policies, procedures, and standards.

EDUCATION & EXPERIENCE REQUIRED

• Bilingual (English and Spanish) – Required
• High school diploma or equivalent; AA Degree preferred
• Minimum of 1 year of experience in healthcare-related social services, case coordination, or patient support
• Minimum of 2 years of experience working with database systems and Microsoft Office applications
• Minimum of 1 year of general office or administrative experience
• Community Health Worker (CHW) Certification (to be obtained within 1 year; agency-funded)
• Exchange Enrollment Facilitator License (to be obtained within 90 days; agency-funded)
• Ability to successfully pass Medicare/Medicaid fraud screening

WORK ENVIRONMENT & PHYSICAL REQUIREMENT

• The noise level in the work environment is usually moderate, and the employee usually works in a climate-controlled office environment
• Be able to sit at a computer for up to 6 – 8 hours per day
• Be able to stand between 3 – 6 hours per day.
• Be able to withstand frequent hand/wrist deviation and repetition
• Must be able to lift, carry up to 30 pounds with a fair consistency

The statements herein are intended to describe the general nature and level of the position, but are not necessarily a complete list of responsibilities, duties and skills required of employee(s) so classified. As such, responsibilities, duties, and required skills may be changed, expanded, reduced, or deleted to meet the business needs of Access to Healthcare Network. Furthermore, they do not establish a contract or implied contract for employment.

FUNDING CLAUSE

This position is funded through external grant sources. Continued employment is contingent upon the ongoing availability of this funding. If funding is reduced or discontinued, the position may be changed or eliminated.

As an equal opportunity employer, we are committed to identifying and developing the skills and leadership of people from diverse backgrounds. We encourage all qualified candidates to apply.

BENEFITS

• Medical Insurance & Vision provided at no cost to the Employee
• Health Savings Account HDHP (HSA) includes employer matching $35.00 per month
• Dependent Care Flexible Savings Account (FSA)
• Low-cost health insurance options for your dependents
• Dental Insurance
• Free Life Insurance and Long-Term Disability
• Voluntary Ancillary Benefits
• 4 Weeks Paid Time off in your first year
• WFH Options
• 14 Holidays
• Bereavement Leave
• 4 weeks Paid parental leave
• Tuition Assistance and more!

Required to pass a background check through the State of Nevada