SUMMARY:

The Eligibility Specialist is responsible for providing patients with information regarding eligibility and enrollment for various programs and third party payers. The Eligibility Specialist will review financial information and determine patient’s financial eligibility for sliding fee discounts, and will assist patients in completing applications.

QUALIFICATIONS:

•  High School Diploma or GED.
• Community Health Worker certification is preferred.
•  Bilingual- English/Spanish is preferred.
• 3 years of customer service experience.
• Knowledge of Medical Terminology is preferred.
• Must be proficient in MS Word and Excel.
• Excellent Interpersonal and Communication Skills.
• Must have a current BLS or BLS equivalent certification.
• Community Health Worker Certification is required or obtain certification within the first year of employment.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Verify insurance coverage for next day’s schedule using practice management system appointment reports
2. Review patient’s financial information to determine eligibility for various payers, assist patients in completing applications to specific health care plans
3. Coordinate with the Medicaid case worker to enable qualified clients to enroll in Medicaid or other appropriate public health programs
4. Assist patients in completing applications and qualifying for sliding fee discounts using all required documents
5. Responsible for maintaining patients demographic information insert new/updated clinical and administrative documentation in charts
6. Enters financial eligibility portion of enrollment package into the system
7. Gathers third party payment information
8. Discusses SBCHC services and policies with new patients
9. Follow up pending applications and payment vouchers
10. Participates in all safety programs which may include assignment to an emergency response team
11. Performs other duties as assigned.
12. All Health Center staff members have emergency and disaster response responsibilities. Participates in all safety programs which may include assignment to an emergency response team.