Patient Eligibility Assistant - Remote

Chronic Care Staffing is Hiring a Patient Eligibility Assistant!

Location: Remote
Schedule: Full-Time
Pay Rate: $15–$16/hour
Employment Type: Full-Time (Hourly)

Overview

The Patient Eligibility Assistant plays a vital role in ensuring patients meet all medical and administrative requirements for participation in healthcare programs governed by CMS guidelines. This is a non-clinical, remote administrative role that focuses on verifying patient eligibility, confirming provider encounters, and reviewing insurance coverage.

You’ll collaborate closely with both clinical and administrative teams to maintain accurate, efficient, and compliant enrollment processes. The ideal candidate is detail-oriented, tech-savvy, and experienced in handling confidential healthcare information within EHR systems.

Responsibilities

• Confirm Program Eligibility:
• Review patient data to verify eligibility for programs such as Chronic Care Management (CCM) and Remote Patient Monitoring (RPM).
• Confirm that patients have two or more chronic conditions listed in the CMS Chronic Condition Data Warehouse (CCDW).
• Consult a supervisor or team lead for conditions not listed in CCDW.

• Patient Encounter Verification:
• Verify that patients have seen their Primary Care Provider (PCP) or a relevant specialist within the past 12 months.
• Review EHR documentation to confirm that eligibility requirements are met.

• Insurance Verification:
• Review and confirm patient insurance coverage details in the EHR.
• Compare patient insurance against practice-specific contracted insurers to confirm eligibility.

• Administrative Accuracy & Compliance:
• Maintain meticulous documentation in compliance with HIPAA regulations.
• Communicate eligibility status and updates with internal teams.

• Proficiency with Electronic Health Record (EHR) systems (e.g., eClinicalWorks and/or Athena).
• Experience with Medicare and commercial insurance verification.
• Strong attention to detail when reviewing medical or insurance documentation.
• Excellent communication, time management, and organizational skills.
• Familiarity with Google Suite and other company-approved software tools.
• Ability to maintain confidentiality and comply with HIPAA regulations.

Preferred (Nice to Have)

• Previous experience in healthcare administration, patient eligibility review, or insurance verification.
• Understanding of CMS eligibility requirements and chronic condition criteria.