Insurance Eligibility Specialist

Job description

Description Nashua, NH: Greater Nashua Mental Health is seeking an Insurance Eligibility Specialist to support accurate insurance coverage, Medicaid eligibility, and billing readiness for services delivered across the agency. This role works primarily behind the scenes, focusing on EMR accuracy, Medicaid spenddown processes, and collaboration with Benefits and Revenue Cycle teams to support reimbursement and continuity of coverage. Key Responsibilities: - Review, verify, and maintain accurate insurance coverage information in the EMR, including Medicaid, Medicare, and commercial payers. - Monitor Medicaid eligibility, coverage status, payer sequencing, and spenddown requirements. - Track and submit medical bills to the state to support Medicaid spenddown activation and ongoing eligibility. - Ensure client accounts meet billing readiness standards and documentation requirements. - Assess eligibility for uninsured clients for state medical or financial assistance programs. - Determine and document client financial responsibility, including insurance, grants, and charity care. - Review eligibility reports daily and update coverage based on identified changes. - Identify trends and err...