Eligibility Clerk

Position Summary: Interviews patients to determine eligibility status for medical assistance programs and assists with application process. Verifies enrollment and demographic information for accurate and timely reimbursement of charges. Facilitates processes by maintaining current documentations and reports. Provides customer service to patients and families by answering inquiries and explaining program coverage and available local resources.

Critical Tasks:

• Interviews and contacts patients, families, and related agencies to determine patient eligibility and enrollment status for government-sponsored insurance coverage.
• Documents all activities associated with interviews and creates regular status reports.
• Assists patients in completing applications and verifies enrollment and demographic information for accuracy and completeness. Makes corrections as appropriate.
• Provides instructions and guidance to patients and families regarding program coverage and local resources. Responds to any inquiries or complaints as primary contact.
• Maintains approval and denial files current to facilitate renewals and reinstatement processes.
Updates patient database in accordance with healthcare coverage for billing and reimbursement. Performs other job-related activities as requested.

Required Qualifications:

• High school diploma or GED required.
• Associate’s degree in a healthcare-related field preferred.
• 1 year of experience in a healthcare patient-facing clerical / recordkeeping setting preferred.
• Previous work experience with government-sponsored medical assistance programs or healthcare insurance verification and policy preferred.
• Knowledge of government-sponsored medical assistance programs and associated agencies preferred.
• Exceptional communication, interpersonal, and customer service skills.
• State of Arizona driver’s license with no significant violations during the last 5 years.
• Demonstrates ability to relate to diverse cultures and specifically the Gila River Community and/or other Native American cultures and community health services.