Eligibility & Enrollment Specialist (Bilingual English/Spanish)

Job Summary
We are seeking a detail-oriented and knowledgeable Eligibility Specialist to join our team. The ideal candidate will play a crucial role in determining patient eligibility for various medical and dental services. This position requires a strong understanding of medical terminology and administrative processes within a healthcare setting. The Eligibility Specialist will work closely with patients, healthcare providers, and insurance companies to ensure accurate and timely processing of eligibility requests. The Eligibility and Enrollment Specialist is responsible for interviewing and counseling individuals who are uninsured or underinsured, assisting them to fill out the necessary forms and to secure required accompanying documentation and maintaining tracking system of applications as well as serving as patient advocates.

Responsibilities

• Educate clients on the different coverages offered through the New York State of Health, helping them to understand the benefits and limitations of their coverage.
• Aid with recertification for Medicaid through Human Resources Administration
• Assist with Medicaid application completion through the Human Resources for the aged, blind, and disabled.
• Provide persons who are interested in becoming Settlement Health Patients with an introduction to Settlement Health’s services and link them to the appropriate department to set up an appointment.
• Serve as patient advocate on insurance related matters
• Ensure that Eligibility & Enrollment Specialists are attending all scheduled trainings by Settlement Health, New York State Of Health and CMS needs to report to Valerie Mercado on who attended scheduled trainings by the end of that month.
• Works effectively and efficiently, able to work on several things at once while maintaining expected productivity outcomes. Meets established productivity goals without sacrificing quality.
• Understands and meets the needs of external and internal customers. Puts the customer at the center of services, systems, and processes.
• Demonstrates a deep understanding of our colleagues, our patients and their loved ones through inclusion, compassion, respect and caring.
• Provide follow-up for missed eligibility screening appointments. This includes follow-up by telephone and/or letter. Make appointments for prenatal Medicaid Pre-Screening clients when necessary.
• Any other related duties as delegated by supervisor.

Team Focused Provision of Care

Works as a part of an assigned care team, defined as – provider, medical assistant, nurse, referral coordinator, with the option of including care manager, nutritionist and behavioral health provider, as indicated. Team based communication is an expectation and should include interaction with support staff (MOAs, Call Center, enabling service providers) to encourage the engagement of the patient as a part of the care team.

Electronic Medical Records & Computer Responsibilities:

• Responsible for the daily utilization of the Electronic Medical Record, Athena Practice.
• Documentation of patient encounters whether in person or via telephone in the Electronic Medical Record.
• Initiate communication and/or follow-up using the EMR flag system to Clinicians, Referral Coordinator, and other Support Staff.
• Utilization of appropriate service reports to conduct outreach, tracking and follow-up of patients, with documentation of activities in the Electronic Health Record.
• Required to attend trainings and workshops to refresh and improve knowledge of the EMR.
• Competency of basic computer skills, to include but not limited to Microsoft Outlook.
• Check emails in Microsoft Outlook on a daily basis (minimum).

Experience

• Previous experience in a medical office or dental office setting is preferred.
• Familiarity with medical terminology is essential for effective communication and documentation.
• Experience in medical administrative support roles will be considered an asset.
• Strong organizational skills with attention to detail are required for managing multiple cases efficiently.
• Proficiency in office software applications is necessary for record keeping and communication.

Qualifications

EDUCATION/EXPERIENCE

• High School Diploma

SKILLS AND KNOWLEDGE

• Bilingual English/Spanish fluency required
• Strong Organization Skills
• Proven ability to manage complex tasks and prioritize multiple responsibilities
• Strong attention to detail with expertise in managing documentation and follow-up procedures
• Ability to interview and counsel patients
• Ability to collaborate effectively with state officials
• Experience with a Medicaid program is highly desirable
• Experience with Electronic Health Records preferred
• Computer proficiency is required

AVAILABILITY REQUIREMENTS

• Available to work one evening and/or weekend a week when needed

Join our dedicated team as an Eligibility Specialist, where your expertise will directly impact patient care and access to essential health services.

Job Type: Full-time

Pay: $22.00 - $24.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Retirement plan
• Vision insurance

Education:

• High school or equivalent (Required)

Language:

• Spanish fluently (Required)
• English fluently (Required)

Ability to Commute:

• New York, NY 10029 (Required)

Work Location: In person

Salary : $22 - $24