Patient Eligibility Coordinator (PEC)

TITLE: Patient Eligibility Coordinator (PEC)

REPORTS TO: Provider and Patient Coordinator Manager

WORK WEEK: Not to exceed 40 hours per week

WAGE CLASSIFICATION: Non-Exempt

OSHA RISK CLASSIFICATION: Medium

STARTING SALARY: $21.00 per hour with benefits

Summary Position Statement

Under the supervision of the Provider and Patient Coordinator Manager, working closely with the CFO, this position conducts enrollment activities for PCHS to identify, contact and enroll uninsured patients and community members into health insurance coverage. Assists all PCHS staff with processes that identify uninsured patients and enroll them in insurance for which they qualify. Participates in outreach activities on behalf of PCHS. PCHS manages patient care using a team-based approach in our interactions with patients and working to achieve stated objectives and outcomes.

This Position Will

• Assist qualified patients to enroll into Sliding Fee discount and then determine their eligibility for same.
• Facilitate the process for patients to access outside financial assistance.
• Provide information to patients and clients about PCHS’s policies and procedures as they pertain to enrollment and eligibility for available financial programs.
  
  

ESSENTIAL FUNCTIONS/ROLES & RESPONSIBILITIES OF THE POSITION

• Functions in accordance with and in support of PCHS’s mission, vision, policies and procedures.
• Check Insurance eligibility for patient coverage in advance of scheduled appointments by scrubbing provider schedules. Contact any patient whose insurance fails eligibility to obtain current insurance information prior to patient appointment.
• Assist patients who need help filling out agency paperwork. At time of patient check-in, assist all new patients as well as existing patients in need with the registration process including reviewing insurance coverage and eligibility for Medicare, Medicaid, Marketplace, and Sliding Fee Discount Program. Assist patients in gathering their data. Assure completeness of clinic forms.
• Interview patients to assist with and begin the process to access financial assistance; procure necessary paperwork from patients, including proof of income and any other pertinent documents. Determine a patient’s eligibility for PCHS’s in-house discount/sliding fee scale, input sliding fee information into the practice management system.
• Update patient eligibility and financial information on a regular basis as required under the Sliding Fee Discount Program.
• Establish a positive working relationship with outside agencies; develop a collaborative working relationship with contact person.
• Coordinate with in-house case managers and community resources to facilitate a patient/client application process to outside agencies; whenever applicable, do an intra-agency referral to a case manager. All billable services will be referred to an appropriate in-house staff member.
• Access and have a basic understanding of all agency practice management systems.
• Specifics required by ACA law: The navigators are expected to provide “fair, impartial, and accurate information that assists consumers with submitting the eligibility application, clarifying distinctions about qualified health plans and helping qualified individuals make informed decisions during the health plan selection process”. They will also provide additional assistance to consumers, who are disabled, do not speak English, or who are unfamiliar with health insurance.
  
  

The proposed guidelines specify that while navigators do not have to be licensed insurance agents or brokers, they:

• Cannot be employed by an insurer;
• Cannot receive compensation or rewards from carriers;
• Must disclose what other lines of insurance they intended to sell during their work;
• Must disclose any prior employment with health insurers in the previous five years; and
• Must certify that they will abide by conflict of interest and impartiality standards developed by HHS.
• The proposed rule also states that navigators cannot select a plan for their clients, and that they are not tasked with determining whether a client is eligible for a subsidy through the ACA.
  
  

Navigator must not have a personal interest in the coverage choices made by individuals or employers who receive the navigator’s assistance, “More specifically, with respect to the assistance offered by a navigator to a small employer, a navigator should not have a personal interest in whether a small employer choose to self-insure its employees or chooses to enroll in full-insured coverage inside or outside the exchange.”

Must pass drug test and State required background.