Insurance Eligibility Specialist at Community Council of Nashua INC – Nashua, New Hampshire

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 errors impacting claims adjudication and collaborate with Revenue Cycle and Billing teams to resolve issues.

• Partner with Client Benefits, IT, and management to improve insurance and claims processes.

• Serve as an internal liaison with agencies such as NH Medicaid.

• Provide guidance and training to staff on insurance processes and EMR documentation requirements.

• Support authorization and referral processes by ensuring required documentation and EMR updates are complete.

• Assist with reporting, special projects, and process improvement initiatives.

Qualifications

• High School Diploma or GED required; Associate’s degree preferred.

• 2–4 years of experience supporting medical billing, insurance eligibility, or revenue cycle operations.

• Knowledge of Medicaid, Medicare, and commercial insurance eligibility processes.

• Experience working with EMR systems and reviewing insurance data.

• Strong analytical skills, attention to detail, and ability to resolve complex issues.

• Proficiency with Microsoft Office, including Excel.

• Strong communication, collaboration, and organizational skills.

• Ability to multitask and work effectively in a fast-paced environment.

Why Work for Us

• Two health plan options

• HRA, HSA, FSA

• Dental & vision coverage

• Life, AD&D, short/long-term disability

• Accident & critical illness insurance

• 403(b) with up to a 5% match

• Generous earned time off + extended sick time

• 10 paid holidays

• Tuition reimbursement

• Eligible for Public Service Loan Forgiveness & NH State Loan Repayment

Salary Range: $21.28/hr - $28.12/hr

Greater Nashua Mental Health is an Equal Opportunity Employer.