Health Care Enrollment Specialists determine the type of care for which patients in a clinic or hospital are eligible. They also verify patients’ eligibility with their insurance carrier, collect health records, and manage medical care forms. Health insurance companies also employ Enrollment Specialists. In that setting, they assist customers with enrolling in health care programs, answer questions about benefits, and maintain current customers.
Health Care Enrollment Specialists need to possess administrative and organization skills and communication and customer service skills. Candidates should also be well-versed in all aspects of the programs for which they enroll customers and patients so that they can pass along accurate information.
Typical Duties and Responsibilities
- Answer questions, resolve issues and provide detailed information on requirements, processes, and policies
- Make sure patients are qualified for care, and verify health coverage for that care
- Check applications and forms to be sure they are completed correctly and include the proper supporting documents
- Create and maintain patient and customer records
Education and Background
This position requires a high school diploma or its equivalent. However, employers prefer candidates with an associate degree or higher, especially in subjects like health care administration.
Skills and Competencies
- Robust written and verbal communication skills
- Ability to communicate calmly and diplomatically with customers and patients
- Keen attention to detail, especially involving checking forms and documents for proper information
- Working knowledge of Microsoft Office Suite or similar software
- Customer service skills
- Knowledge of medical insurance procedures
- Active listening and comprehension skills
- Working knowledge of office equipment such as copiers, printers and fax machines
According to Payscale the median annual salary of a Health Care Enrollment Specialist with
1 year of experience:
- Orlando, Florida: $33,000
- Tampa, Florida: $38,000
- Jacksonville, Florida: $31,000
- Miami, Florida: $50,000
- Atlanta, Georgia: $48,000
- Chicago, Illinois: $44,000
- Houston, Texas: $38,000
- Los Angeles, California: $50,000
- New York, New York: $53,000
- Seattle, Washington: $56,000
- Overall: $45,000
5 years of experience:
- Orlando, Florida: $42,000
- Tampa, Florida: $45,000
- Jacksonville, Florida: $38,000
- Miami, Florida: $60,000
- Atlanta, Georgia: $51,000
- Chicago, Illinois: $55,000
- Houston, Texas: $46,000
- Los Angeles, California: $65,000
- New York, New York: $69,000
- Seattle, Washington: $67,000
- Overall: $55,000
Similar Job Titles
- Eligibility and Enrollment Specialist
- Care Specialist
- Provider Enrollment Specialist
- Insurance Enrollment Specialist
This position requires a high school diploma or its equivalent. However, employers prefer candidates with an associate degree or higher, especially in subjects like health care administration. Successful Health Care Enrollment Specialists can advance into management roles or even progress into fields such as client relations or marketing strategy.
According to the benefits enrollment firm The Olson Group, the rising cost of health insurance is one trend Enrollment Specialists should be aware of in the coming years. It’s expected to rise by about five percent in 2020. Another health care trend is the increasing popularity of virtual care, otherwise knows as tele-health. More health care providers are choosing this option to treat patients for conditions that don’t necessarily require an in-person visit. It’s becoming the most-utilized health care service in the U.S. Many health insurance programs have specific rules about covering tele-health, so Enrollment Specialists should be as well-versed in the various regulations regarding this kind of care.
According to the U.S. Bureau of Labor Statistics, the Compensation, Benefits, and Job Analysis Specialist field is expected to grow by six percent between 2018 and 2028. That’s about as fast as average.
The typical work hours for a Health Care Enrollment Specialist are from 9 a.m. to 5 p.m., if a health care clinic or facility employs them. Health Care Enrollment Specialists who work for insurance companies or hospitals that offer 24-hour customer service may work non-traditional shifts, including nights, weekends, and holidays.
Where You Can Find Jobs
- 4 Corner Resources
- Career Builder
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