Eligibility Specialist

Legacy Community Health

Houston, TX, USA

Full time

Healthcare / Community Health & Mental Health

Mar 18

This job is no longer accepting applications.

The Eligibility Specialist determines applicant eligibility for third party reimbursement, processes data necessary for admission of new patients into health services, ensure proper coding for insurance billing, and handle inquiries from prospective applicants and patients.


Essential Functions

Essential functions are those tasks, duties, and responsibilities that comprise the means of accomplishing the job’s purpose and objectives. Essential functions are critical or fundamental to the performance of the job. They are the major functions for which the person in the job is held accountable.

  • Conduct eligibility for clients following procedures and guidelines specific to each program.
  • Ensure that clients do not have another payer source such as Medicaid, Medicare, ADAP, and any other third party insurance.
  • Register clients into the CPCDMS.
  • Complete all necessary paperwork.
  • Performs data entry of eligible clients into electronic system.
  • Maintains up-to-date and orderly eligibility files.
  • Conducts renewal eligibility as required by each program.
  • Confirms eligibility appointments with clients.
  • Sets initial service appointments once eligibility has been determined.
  • Provides clients with list of required eligibility documentation.
  • Participates in the Performance Improvement Program.
  • Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to insure a professional, responsible and courteous environment.
  • Promotes effective working relations and works effectively as part of a team to facilitate the department’s ability to meet its goals and objectives.
  • Attends all required safety training programs and can describe his/her responsibilities related to general safety, department/service safety, specific job–related hazards.
  • Attends all required safety education programs.
  • Operates assigned equipment and performs all procedures in a safe manner as instructed.
  • Maintains work area and equipment in condition required by Legacy standards.
  • Demonstrates proper body mechanics in all functions.
  • Checks on the patient’s environment and equipment to insure safety. Reports safety concerns promptly to appropriate personnel.
  • Follows Legacy’s exposure control plans/blood borne and airborne pathogens.
  • Demonstrates knowledge of techniques, procedures and correct use of protective barrier equipment (Universal Precautions).
  • Assures a safe environment by instituting appropriate control measures.
  • Attends annual education programs.


Education & Training Requirements

  • High School Diploma or equivalent required.
  • Bilingual preferred

Work Experience Requirements

  • A minimum of 3-5 years of medical billing experience preferred.
  • Some training or background in ICD-A / CPT codes preferred.
  • Ability to understand and practice bookkeeping and accounting terminology required.
  • Knowledge of medical terminology and billing practices preferred.
  • Ability to operate computers and other office machines required.
  • Must be able to take responsibility and work under pressure.



  • 9 Holiday + 1 Floating Holiday
  • PTO
  • 403b Retirement Plan

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Legacy Community Health

Driving healthy change in our communities.