Eligibility and Benefits Specialist

Lighthouse Behavioral Health Solutions (LBHS) provides individual, outpatient, intensive outpatient, partial hospitalization, residential, psychiatric services, and medication assisted treatment for mental health and substance abuse treatment needs. We are a treatment facility that prides itself in a welcoming and compassionate approach to substance use and mental health treatment. We believe our clients can achieve recovery and be valued community members through positive engagement and meaningful participation in treatment.

Our Goal:

Our comprehensive approach to addictions treatment provides a continuum of care that begins with asking for help and continues through to ongoing peer support. In addition to our state-of-the-art treatment facilities and peer support centers across Central Ohio, we work to remove barriers and promote access to care through our integrative approach and evidence-based clinical treatment.

Join our exciting and fast-growing company in which you will have an impact on improving people's lives! Lighthouse Behavioral Health Solutions (LBHS) is looking for quality candidates who are pursuing professional growth in a supportive environment and can thrive in a collaborative team-focused culture.

• 9 Paid Holidays
• Paid Time Off
• Sick Time Off
• Paid continuing education opportunities
• Paid parental leave
• Medical/Dental/Vision
• 401(k)
• Life Insurance
• STAR/HRSA/Ohio student loan forgiveness programs (for applicable roles and locations)
  
  

Position: Eligibility and Benefits Specialist

Job Summary: The Eligibility and Benefits Specialist responsible for assisting clients with navigating and securing appropriate healthcare coverage and benefits. This role involves processing presumptive eligibility for clients, assisting clients with obtaining EBT and cell phones, conducting biweekly/weekly verification of benefits, acting as a liaison for Job and Family Services (JFS), and providing financial counseling to clients regarding copays, coinsurance, deductibles, and payment plans. This position reports to the Director of Revenue Cycle Management.

Duties and Responsibilities:

Duties include, but are not limited to:

• Assess and process presumptive eligibility for clients across the organization, ensuring that all necessary documentation is accurately gathered and reviewed to determine initial eligibility for services.
• Ensure the accurate and timely submission of eligibility-related documentation, meeting all regulatory requirements and internal standards for documentation quality and compliance.
• Accurately input eligibility and benefit information into the company's EMR/Billing system (Carelogic), ensuring that all client data is up-to-date, properly recorded, and accessible for clinical and financial teams.
• Track and monitor each client's eligibility status from the initial determination through to completion, ensuring they obtain the appropriate Managed Care Organization (MCO) plan, and address any barriers that may arise during the process.
• Offer clear guidance and consistent support to clients throughout the application process, communicating the steps involved and assisting them in gathering any additional documentation required for eligibility determination.
• Conduct biweekly and weekly verification of benefits for clients across the organization.
• Maintain accurate records of benefit verification and update client files to reflect the latest eligibility and benefits information in accordance with compliance standards.
• Serve as the primary point of contact between the company and JFS to ensure clients receive necessary services, including eligibility determination, financial assistance, and health benefits. Collaborate to resolve any eligibility discrepancies or concerns promptly.
• Educate clients about their financial obligations, including copays, coinsurance, deductibles, and other costs associated with their care. Provide transparent and clear explanations of payment expectations and financial responsibilities.
• Work with clients to develop individualized payment plans that consider their financial capabilities and treatment needs.
• Ensure that clients are fully informed about their financial options, including sliding-scale fees, payment assistance programs, and other support available to reduce financial barriers to care.
• Perform other duties as assigned.
  
  

Requirements:

• High school diploma or equivalent
• At least 2 years of experience in healthcare benefits, eligibility verification, or insurance coordination, preferably in a behavioral health, substance use disorder (SUD), or addiction treatment setting
• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Proficiency in using relevant software and systems for eligibility processing and benefit verification
• Must pass BCI check, all Corporate Compliance checks, and employment drug screen.
  
  

Desired Experience:

Associate's or Bachelor's degree in healthcare administration, social work, business, or a related field

Compensation: $22.16 - $29.57/hr

Schedule: Monday - Friday 8:30a-5pm

Location: 140 E Town St Columbus, OH 43215

LBHS offers benefits such as competitive compensation based on industry standards, health insurance benefits which include medical/dental/vision/life/disability, paid time off, paid holidays, 401k plan, Employee Assistance Program (EAP), education reimbursement program, and paid parental leave.

Lighthouse is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, age, color, religion, sex, national origin, sexual orientation, disability status, genetics, gender identity and/or expression, protected veteran status, or any other characteristic protected by federal, state, or local law.

LBHS adheres to Title VII of the Civil Rights Act as amended, Ohio Civil Rights Act, and all applicable rules and regulations. LBHS is an equal opportunity employer.