An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
SRH Business Center The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.
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Job Summary The Insurance Authorization Lead is responsible for ensuring all pre‑service administrative requirements are met for scheduled appointments while also providing day‑to‑day operational support, guidance, and leadership to the Insurance Authorization team. This role works effectively and cooperatively within the workplace and may include location‑ or department‑specific tasks and competencies. Essential Functions The Insurance Authorization Lead supports daily team operations by assisting with onboarding and training of new team members, helping assign work queues and daily or weekly tasks, and maintaining cross‑training across all Insurance Authorization areas to provide coverage during unplanned absences. The Lead serves as a primary resource for team questions related to prior authorizations and workflow steps, assists with denial work queues and patient communication when needed, and helps maintain and update training tools such as OneNote, tip sheets, and workflows. The role also provides daily operational support with work queues and additional assignments, including EPIC Secure Chats, In‑Basket messages, faxes, and emails. In addition to these lead responsibilities, the Lead performs all standard authorization duties, including documenting eligibility, benefit, and authorization information; initiating insurance requirements for specific admission types; verifying prior authorizations and pre‑service requirements; referring self‑pay patients to Patient Financial Services; reviewing and resolving denial issues; verifying current eligibility and plan coverage; and tracking and submitting retro‑authorization requests in collaboration with referring offices. The Lead utilizes available tools and online resources to improve efficiency, maintains proficiency in Microsoft Office and department‑specific software, communicates effectively within the workplace, contributes to Quality and Lean Process Improvement initiatives, completes mandatory learning requirements, participates in meetings, and complies with all Skagit Regional Health policies and procedures. Other duties may be assigned by the Supervisor or designee. Education High School graduate or GED required. Experience/Training Minimum three (3) years insurance authorization experience strongly preferred. An equivalent combination of education and experience may be considered. License/Certifications None required. Other Skills Effective verbal, written and interpersonal communication skills required. Must be able to effectively utilize Microsoft Office applications to perform work. Well-developed problem solving and analytical skills required. Must be able to effectively prioritize workload amongst frequent interruptions with competing priorities. Knowledge of current coding rules and guidelines. Must possess a basic understanding of anatomy, physiology, disease process and medical terminology. Ability to coordinate work schedule with requirements of position (may include overtime and weekend work). Physical Demands and Work Environment The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.
Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.
