Health Insurance Specialist - 24.04

Job Description

Job Description

JOB PURPOSE :

The Health Insurance Specialist is responsible for maintaining the highest professional and ethical standards in representing Access to Health Network (AHN) to HIV / AIDS clients and business partners. The ideal candidate is a motivated, hard-working, organized individual who performs well under pressure and can multi-task. This position is responsible for assisting clients with enrolling into the appropriate insurance product, processing Nevada Medication Assistance Program (NMAP) referrals from partner agencies, processing binder payment to insurance carriers, as well as cost share assistance payments for medical, dental, and / or vision claims / invoices.

Basic Requirements

This role requires bilingual fluency in English and Spanish, a valid Government Issued Driver's License or ID card, and the ability to pass a State of Nevada background check. Candidates must comply with HIPAA regulations. Within 90 days of hire, an Exchange Enrollment Facilitator License (EEF) must be obtained (at the agency's expense) as well as the Community Health Worker certification (CHW) within one year. A general understanding of health insurance systems, AHN services, and administrative duties is essential. Attendance at staff meetings and regular check-ins with direct reports is also expected.

Key Responsibilities

The position involves working knowledge of healthcare programs such as Medicaid, Medicare, Nevada Check-Up, and others. Compassionate, respectful service to clients is essential. Responsibilities include eligibility screening for Ryan White services, processing referrals and premium payments, and assisting with enrollment in the Premium Assistance Program.

You'll be expected to maintain accurate client records in CareWare and Salesforce, ensure timely and professional reporting, and determine payer sources for NMAP referrals. Building strong relationships with providers, partners, and funders is key. The role also requires adaptability to changing schedules and duties, critical thinking, and the ability to communicate complex concepts clearly. Familiarity with Salesforce and CAREWare is necessary, and other duties may be assigned as needed.

EDUCATION MINIMUM :

• High School Diploma; AA Degree Preferred.

EXPERIENCE MINIMUM :

Required to pass a background check through the State of Nevada