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How to Become a Healthcare Enrollment Specialist

If you have an interest in working in the healthcare industry, have good sales and people skills, and exceptional communication skills, a career opportunity as a healthcare enrollment specialist could be a perfect fit.

Healthcare enrollment specialists typically work for healthcare facilities where they advise patients on the type of care they are eligible for based on their insurance. They verify eligibility with insurance carriers, obtain health records, and manage medical care forms. Enrollment specialists also work for insurance companies, assisting customers with enrolling in health care programs. They process applications, address any questions or concerns about benefits, and provide advice on programs or services. 

Healthcare enrollment specialists should have excellent attention to detail and outstanding listening skills as they advise and guide candidates in the enrollment process. They ensure that applications are completed accurately and that all required information has been provided. They must have competent computer skills to enter and update online data. Exceptional customer service skills are required, as are strong organizational abilities. If you have a passion for helping others and assisting them in enrolling in the right healthcare programs, consider a career as a healthcare enrollment specialist.

Sample job description

A healthcare enrollment specialist is needed at [Your Company Name]. It is this position’s job to review clients’ and patients’ eligibility for medication, surgeries, and other medical procedures prior to meeting with doctors, nurses, etc. This gives the opportunity for doctors and specialists to prioritize their time with those that have already been checked for eligibility. You must collect applications, information, and give advice to customers seeking it. The ideal candidate will be required to have a nuanced understanding of all of the services provided by the healthcare clinic. Some critical skills required to do well in this job are good communication skills, problem-solving skills, organization, and the ability to work closely with applicants. Data is another responsibility that lies on the shoulders of the enrollment specialist. This includes data entry, updating, and review. If this description seems like something you would thrive in, consider applying! 

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 experience

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.

Required skills and qualifications

  • ust 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

Preferred qualifications

  • Experience managing healthcare
  • Knowledge of government assistance and health insurance programs
  • 4+ years working with health insurance
  • Knowledge of HIPAA
  • Bachelor’s degree in health or related field
  • Familiar with administrative software i.e. Google Workspace/G-Suite

Typical work environment

This job may be in primary health care clinics, addiction services, mental health clinics, specialized clinics, birth centers, blood banks, and other facilities. Because the majority of healthcare is open day and night, you can expect your shift to be outside the hours of a regular job. This includes early morning, evening, and night shifts. Long portions of your day may be explaining policies, procedures, pricing, and regulation with customers. Oftentimes, this may be handling an upset client, so having the ability to not be affected by inappropriate behavior is a necessity. Based on the niche of healthcare that you work in, different data entries will be required. For example, if you work in mental health services, you can expect data to be centered around medication and behavior. In comparison, working at a hospital will be much vaguer, and data entries may include surgeries, appointments, and things of the like. 

Typical hours

The typical work hours for a health care enrollment specialist are from 9 AM to 5 PM, 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.

Available certifications

Due to the complexity of healthcare, there are multiple certifications available. Some of the most popular include:

  • PESC. The provider enrollment specialist certificate allows you to prove your worth in the field. It is designed to expose knowledge and skills that you may be lacking in, giving you the boost needed to become a top-quality enrollment specialist. By getting this certificate, you are also proving that you are dedicated to serving this career, rather than having it as a short-term job. 
  • CMS. Centers for Medicare and Medicaid Services offers an exam and certificate for those wanting to prove themselves in the healthcare field. With this certificate, employers give higher trust in your abilities and therefore give higher pay. If you’re looking for a new job, having this certificate will be a large bonus to your resume.

Career path

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.

US, Bureau of Labor Statistics’ job outlook

SOC Code: 13-1141

2020 Employment91,900
Projected Employment in 2030100,700
Projected 2020-2030 Percentage Shift 10% increase
Projected 2020-2030 Numeric Shift8,800 increase

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.