What are the responsibilities and job description for the Eligibility and Enrollment Specialist Primary Care Setting position at Southwest Care Center (SCC)?
Southwest Care Center employees can answer yes to these 3 questions:
Southwest Care Center is currently seeking full-time Eligibility and Enrollment Specialist to support our Jefferson Clinic in Albuquerque, NM.
Position Details
Under the direction of the Ancillary Services Manager, the Eligibility and Enrollment Specialist is responsible for the patient insurance verification process to ensure proper payment from insurers and to provide assistance that reduces out-of-pocket expenses related to all services performed in a clinical setting, including HIV/HCV services and PrEP/Sexual Health services. The specialist assesses and enrolls patients in assistance programs for which they qualify, interprets and applies the sliding fee scale, and ensures that all related documentation is accurately and consistently recorded in the electronic medical record. Additionally, the specialist enrolls eligible patients into the Ryan White HIV/AIDS Program case management services and assigns them to a case manager. They ensure patients are scheduled for services, track open referrals to support proper follow-through of appointments, and maintain cross-departmental support and collaboration.
Position Responsibilities Include But Not Limited To
Apply today and we will connect you with a member of our recruitment team. We look forward to speaking with you soon.
If you experience difficulty applying or need assistance please contact HR@southwestcare.org.
The Land of Enchantment offers residents a way of life that you won’t find anywhere else in the United States. Our clinic locations are in Santa Fe and Albuquerque, NM. Each with its own unique vibe and both offering all the perks you get when you call New Mexico Home.
Job Details
Location:
NM Albuquerque
Worker Type
Employee
Regular
Scheduled Weekly Hours
40
- Do you want to make a difference?
- Do you believe everyone is entitled to quality healthcare?
- Do you desire to serve the underserved in your community?
Southwest Care Center is currently seeking full-time Eligibility and Enrollment Specialist to support our Jefferson Clinic in Albuquerque, NM.
Position Details
Under the direction of the Ancillary Services Manager, the Eligibility and Enrollment Specialist is responsible for the patient insurance verification process to ensure proper payment from insurers and to provide assistance that reduces out-of-pocket expenses related to all services performed in a clinical setting, including HIV/HCV services and PrEP/Sexual Health services. The specialist assesses and enrolls patients in assistance programs for which they qualify, interprets and applies the sliding fee scale, and ensures that all related documentation is accurately and consistently recorded in the electronic medical record. Additionally, the specialist enrolls eligible patients into the Ryan White HIV/AIDS Program case management services and assigns them to a case manager. They ensure patients are scheduled for services, track open referrals to support proper follow-through of appointments, and maintain cross-departmental support and collaboration.
Position Responsibilities Include But Not Limited To
- Assess and enroll eligible patients into Ryan White HIV/AIDS Program case management services at intake.
- Determine the patient’s level of Ryan White Sliding Fee Scale and Cap on Charges and educate patients about these benefits.
- Assign the patient to the appropriate specialty provider or facility based on the patient’s current medical needs as defined by the primary care provider.
- Provide all the required medical history information regarding the patient to the specialty provider or facility.
- Coordinate with insurance carriers and specialty practices to obtain prior authorizations, pre certifications and referrals on applicable plans which include HMO, PPO and POS health plans and documents all benefit information into the patients’ electronic medical record.
- Attend weekly specialty services meetings as assigned.
- Scheduling diagnostic testing for HCV patients if applicable
- Scheduling HCV patient medication shipment if applicable
- Coordinating HCV patient prior authorization if applicable
- Maintain contact with patient to ensure compliance with HCV program requirements.
- Schedule necessary provider visits for patients if needed
- Assist with HOPWA certifications if applicable
- HOPWA reporting if assigned
- Weekly, Monthly and Quarterly reporting as assigned
- Weekly food pantry inventory/ordering as assigned
- Other duties as assigned.
- Minimum high-school diploma and minimum 1 year working in a similar role of enrollment and or referrals. Prefer bachelors and 3 years working in enrollment and/or referral role supporting populations as described in this description.
- Valid Driver’s License, Basic Life Support (BLS), NMDOH HIV/HCV testing certification within 12 months of hire.
- Monday - Friday schedule.
- Competitive rate of pay.
- Great work/life balance with generous time off plans.
- Tuition reimbursement availability.
- Full benefits package including medical, dental, vision, 401k, paid time off, professional development programs, and 340B prescription access with substantial employer contribution.
Apply today and we will connect you with a member of our recruitment team. We look forward to speaking with you soon.
If you experience difficulty applying or need assistance please contact HR@southwestcare.org.
- Please note, we are unable to respond to resume inquiries.
The Land of Enchantment offers residents a way of life that you won’t find anywhere else in the United States. Our clinic locations are in Santa Fe and Albuquerque, NM. Each with its own unique vibe and both offering all the perks you get when you call New Mexico Home.
- Rich cultural and historical diversity.
- 310 days of sunshine, combined with a mild, dry climate and four distinct seasons! You’ll forget what humidity is when you live here.
- Unlimited year-round outdoor opportunities including hiking, rock-climbing, rafting, motorized sports, and even skiing. Yes, we have really big ski mountains in and around the deserts of New Mexico!
- Diverse and inclusive communities with amazingly kind people from all walks of life.
- Gorgeous landscapes that include desert and majestic mountains. New Mexico has to be to be seen to believe.
- Continuous festivals, concerts, and events including the internationally known Balloon Fiesta of Albuquerque.
- International airport providing low-cost, quick access in-country and out.
- Big city amenities found in Albuquerque with easy access from Santa Fe (50 min). Many of our employees commute between these cities. Both cities are connected by the NM rail system for those looking for a relaxing commute with a breath-taking view.
- Great schools and family friendly communities.
- And let’s not forget about New Mexican cuisine—it is some of the best food in the country. Will you have red or green?
Job Details
Location:
NM Albuquerque
Worker Type
Employee
Regular
Scheduled Weekly Hours
40