| Location | Greenville, SC |
SCCH2026AllRightsReservedINSURANCEVERIFICATIONSPECIALISTJOBANNOUNCEMENTSantaCruzCommunityHealth(SCCH)isamulti-site,FederallyQualifiedHealthCenter(FQHC)servingSantaCruzCountyresidents.SCCHbeganasawomenshealthcollectivein1974withthemissiontoimprovethehealthofourpatientsandthecommunityandadvocatethefeministgoalsofsocial,political,andeconomicequality.Now,50yearslater,weservethatsamemissionatourthreeclinicsites:theSantaCruzWomensHealthCenterindowntownSantaCruzservingwomenandchildren;theLiveOakHealthCenterservingeveryone;andtheSantaCruzMountainHealthCenterprovidingappropriateandexpandedaccesstocareforourpatientsintheSanLorenzoValley.Drivenbyourcommitmenttohealthcareasahumanright,SCCHisaleadingnon-profitproviderofferingcomprehensivehealthservicestoourpatients,regardlessoftheirabilitytopay.Wehavebeenrecognizedinthecommunityasaleaderindeliveringhigh-quality,innovativecare,andweareactiveinlocal,state,andnationaladvocacyworkthatempowersourpatientsandcommunitytobehealthy,happy,andsuccessful.SCCHhasadiversepatientpopulationandanengagingandfriendlyworkenvironment.Ourcaringandcommittedstaffworkasateamtofulfillourmissionsothatallourpatientshaveaccesstoquality,whole-personhealthcare.POSITIONSUMMARY:TheInsuranceVerificationSpecialistisresponsibleforensuringaccurateandtimelyinsuranceverificationandprogrameligibilityforallSCCHpatients,includingscreeningforeligibilityundertheSlidingFeeDiscountProgram(SFDP).Thisroleworkscollaborativelywithbilling,frontoffice,andenrollmentteamstosupportcleanclaimsubmission,minimizedenials,andoptimizeoverallrevenuecycleperformance.TheInsuranceVerificationSpecialistplaysakeyroleinidentifyinguninsuredandunderinsuredpatientsandfacilitatingaccesstoappropriatecoverageandfinancialassistanceprograms.ThispositioncontributestoapositivepatientexperiencebysupportingaccesstocareandaligningwiththePatient-CenteredMedicalHome(PCMH)model.Thisrolerequiresstrongcriticalthinking,excellentcustomerserviceandcommunicationskills,andtheabilitytomanagemultipleprioritieswithahighlevelofaccuracy.Attentiontodetail,organization,andtimemanagementareessentialtoensurecomplianceandoperationalefficiency.Classification:Full-time,Hourly,Non-exemptLocation:Allclinicsites;PrimarilyWHCReportsto:ClinicManagerHours:Monday-Friday;40hrs/weekLanguage:BilingualinEnglish/SpanishPayRange:$23.23-26.23perhour,DOE.Plus$0.50/hourbilingualdifferentialSpanish/English.SCCH2026AllRightsReservedQualifications:MinimumQualifications:Desiretoservethecommunityclinicpopulationwithexcellenthealthcare.HighSchoolDiplomaorGED.Previoushealthcareexperience,includingknowledgeofHIPAAregulations.Knowledgeofhealthcareterminology,procedures,andpractice.FluentbilingualSpanish/English.Demonstratedabilitytoaccuratelyenter,retrieve,andmaintainpatientinformationinpracticemanagementandEHRsystems.AbilitytoworksomeeveningsandsomeSaturdays.Excellentpatient/customerservice,communicationandfollow-throughskills.PreferredQualification:Bachelor'sdegreeinhealthorrelatedfield.Knowledgeofhealthinsuranceplans.Skills&Knowledge:Knowledgeofstandardhealthcarepracticepoliciesandprocedures.Experienceworkingoncomputers.KnowledgeofMicrosoftOfficesoftwareproducts.AbilitytoworkwithpracticemanagementandEHRsystems.Workingknowledgeofhealthinsuranceplans,eligibilityrequirements,andassociatedfederalandstateassistanceprograms.Abilitytoapplyhealthcareterminologyandstandardpracticeprocedureswhenreviewingpatientregistrationandeligibilityinformation.AbilitytoapplyHIPAArequirementswhenaccessing,discussing,anddocumentingpatientinformation.COREJOBRESPONSIBILITES:ESSENTIALFUNCTIONSINCLUDEBUTARENOTLIMITEDTO:InsuranceVerification&PatientEligibilityUtilizeinsuranceportalsandpayersystemstoverifyeligibilityandbenefitsforallpatients,includingcommercialinsurance,Medicaid,andMedicare.Completepre-visitverificationofinsuranceeligibility,benefits,andpatientdemographic.informationwheneverpossibletosupportcleanclaimsubmissionandreducedenials.Identifyuninsuredorunderinsuredpatientsandreferthemtoappropriateenrollmentoreligibilityassistanceservices.Communicatetopatientsand/orfamiliesregardingpaymentandinsurancerequirementspriortoappointment.SCCH2026AllRightsReservedDocumentandmaintaincomplete,accurate,andtimelyinsuranceandeligibilityinformationintheelectronichealthrecord(EHR).Identifyapplicablecoverageprogramsandensurerequireddocumentationandformsarecompletedpriortooratthetimeofvisit.InsuranceVerification/Pre-RegistrationLeadership&StaffSupportServeasOperations'primaryinternalresourceforinsuranceverificationandpre-registrationprocesses,providingguidancewhileremainingaccountabletotheClinicManager.ProvideguidanceandtroubleshootingsupporttoFrontOfficestaffoninsuranceeligibility,Medi-CalE-Verification,andotherregistration-relatedissues.GuideFrontOfficestaffinresolvingcomplexinsuranceverificationissuesanddeterminingwhenescalationtoBillingisnecessary.Maintaincurrentknowledgeofinsuranceplans,eligibilityrequirements,andverificationprocesses.ProvideongoingtrainingandcoachingtoFrontOfficestafftostrengtheninsuranceverificationandpre-registrationskills.IdentifyrecurringinsuranceandregistrationissuesandpartnerwithOperationsandotherdepartmentstoimproveworkflowsandconsistency.SlidingFeeDiscountProgram(SFDP)AdministrationScreenpatientsforeligibilityundertheSlidingFeeDiscountProgram(SFDP)inaccordancewithFQHCguidelines.Collect,review,anddocumentrequiredincomeandhouseholdinformationaccuratelyandconfidentially.EnsureallSFDPdocumentationiscomplete,current,andcompliantwithorganizationalandregulatoryrequirements.Educatepatientsonslidingfeeeligibility,requireddocumentation,andprogramguidelines.PatientCommunication&FinancialCounselingCommunicateclearlyandrespectfullywithpatientsand/orfamiliesregardinginsurancecoverage,eligibilitystatus,andpaymentexpectations.Provideguidanceonrequireddocumentationandassistpatientsinunderstandingavailablefinancialassistanceprograms.Addresspatientquestionsrelatedtobenefits,coveragelimitations,andout-of-pocketresponsibilities.Maintainprofessionalismandconfidentialitywhendiscussingsensitivefinancialandpersonalinformation.RevenueCycleSupport&CollaborationCollaboratewithbilling,frontoffice,andenrollmentteamstoresolveeligibilityissuesandpreventclaimdenials.Supportefficientrevenuecycleoperationsthroughproactiveverificationandissueresolution.Assistoperationalstaffwithspecialprojectsandworkflowimprovementsrelatedtopatientaccess,eligibility,andverificationprocesses.Participateinthedesign,implementation,andcontinuousimprovementofworkflows,includingpre-SCCH2026AllRightsReservedvisitverificationprocesses.Quality,Documentation&ComplianceEnsureallinsurance,financial,andeligibility-relateddocumentationisscannedandenteredtheEHRaccuratelyandinatimelymanner.Maintaincompliancewithallfederal,state,andorganizationalrequirements,includingFQHCdocumentationstandardsandauditreadinessexpectations.ProtectindividuallyidentifiablehealthinformationinaccordancewithHIPAAregulationsandorganizationalpolicies.Adheretoestablishedworkflows,procedures,anddocumentationstandards.Participateinqualityimprovementinitiativesrelatedtoeligibilityverificationandpatientaccessprocesses.Teamwork&ProfessionalConductAttendrequiredmeetings,training,andorganizationalcommittees.Workcollaborativelywithcross-functionalteamstosupportpatientaccessandoperationalefficiency.Communicateclearly,professionally,andrespectfullywithcolleaguesandleadership,anduseestablishedchannelstoraisequestionsorconcerns.Demonstrateaccountability,reliability,andadaptabilityinadynamichealthcareenvironment.Contributepracticalrecommendationsduringteamdiscussionsandsupportimplementationofagreed-uponsolutions.CoreCompetencies&PerformanceExpectationsInsuranceVerificationSpecialistsareexpectedtodemonstrate:Strongknowledgeofinsuranceeligibilityprocesses,payersystems,andverificationtools.Attentiontodetailandaccuracyindocumentationanddataentry.Abilitytomanagemultipleprioritiesinafast-pacedenvironment.Effectivecommunicationandpatienteducationskills.Problem-solvingabilityandsoundjudgmentinresolvingeligibilityissues.Commitmenttoconfidentiality,compliance,andhigh-qualityservice.GENERALJOBPERFORMANCESTANDARDS:KNOWLEDGEOFWORK-Possesandutilizesknowledgeofthejobwhichisessentialtoperformthespecif-icfunctionsandrelatedwork.QUANTITYOFWORK-Accomplishesanappropriatevolumeofsatisfactoryworkundernormalconditions.Abilitytoproduceresults.QUALITYOFWORK-Consistentlydemonstratesaccuracy,thoroughness,neatnessanddependabilitytoproduceworkwithinacceptablestandards.TIMELINESS-Completesassignmentsonoraheadofschedule.ABILITYTOLEARNNEWDUTIES-Interprets,learnsandrespondstoinstructionsfornewsituations,proceduresormethods.SCCH2026AllRightsReservedJUDGEMENTANDCOMMONSENSE-Decisions/actionsaresound,includingsafetyawareness.COOPERATION-Willingtoworkwithotherstowardcommongoals.COMMUNICATIONS-Demonstratesrelevanceandclarityofwrittenandoralexpression.Effectivenessinexchangingideasandinformation.INITIATIVE-Abilitytooriginate,developorcreatenewideasortakestepstogetthingsdone.PROBLEMSOLVING-Identifiesandevaluatesalternatesolutionsandselectionofthemostappropriatecourseofaction.ATTENDANCEANDPUNCTUALITY-Showsdailyabilitytobeatworkatscheduledtime,includingbeingpreparedtoworkontimeafterbreaks,mealperiods,andotherauthorizedabsencesfromwork.BENEFITSTHATSUPPORTYOU:Weofferacompetitiveandcomprehensivebenefitspackagetosupportemployeewell-beingandwork-lifebalance.Benefitsareavailabletoemployeesworking20ormorehoursperweek,andinclude:Employer-subsidizedmedical,dental,vision,andlifeinsuranceOptionalcoverage:petinsuranceandothersupplementalplansCoveragebeginsthefirstofthemonthafter30daysofemploymentPaidtimeoffandholidaysstartingondayone401(k)planwith2%automaticenrollmentand2%employermatchWellnessreimbursementandtelecommutingstipend(asapplicable)Licenseandcertificationfeereimbursement(asapplicable)InternalStaff:Internalstaffwhotransitionintothispositionwillretaintheircurrentbenefits,tenure,PTOaccruals,andretirementmatchingasapplicable,withnolapseincoverageSantaCruzCommunityHealthisanEqualOpportunityEmployer(W/M/V/D).