Eligibility Specialist

POSITION SUMMARY

The Eligibility Specialist and ADAP Enrollment Worker position has general office duties and serves as a support person to a group of programs. Primary responsibilities are typically; meet with all potential new enrollees for the AIDS Drug Assistance Program (i.e. the Texas HIV Medication Program or THMP); explain THMP program benefits and requirements; and assist clients with the submission of complete, accurate APAP applications greeting clients by phone and in the clinic, assisting with client appointments, establishing client financial eligibility, verifying insurance, assisting senior programmatic staff in day-to-day operations; assisting in grant compliance; preparing correspondence; inputting information into databases and computerized and written report preparation. Significant responsibilities include answering telephone, scheduling appointments, providing the public general information, taking/delivering messages and providing support to clinical and programmatic staff.

ESSENTIAL RESPONSIBILITIES:

• • Answer patient calls and email
  • Scheduling and conduct patient appointments
  • Establish client financial eligibility 
  • Maintain communication with designated THMP staff 
  • Submit patient applications 
  • Ensure each enrollee’s annual recertification is submitted 
  • Proactively contact current THMP enrollees and ensure all necessary documentation is gathered
  • Must document per Texas Department of State Health Services (DSHS) and/or The Houston Regional HIV/AIDS Resource Group (TRG) requirements all activities performed on behalf of THMP enrollees including recertification and semi-annual attestation
  • Communicate with third party billing services, providing documentation as needed
  • Update financial eligibility as needed
  • Assist with regulatory documentation on clinical trials
  • Inventories supplies and maintain inventories, completing purchase requests as needed
  • Provides support to clinical personnel for insurance, Medicaid and Medicare billing
  • Prepares correspondence in a professional style and format
  • Inputs data into databases correctly 
  • Schedules patient appointments 
  • Maintains effective filing system and files necessary information in a timely manner
  • Has extensive understanding of all services, and is capable of relaying information to the patients
  • Assists direct care staff in scheduling clients and coordinating services
  • Assists supervisor in preparing programmatic reports in an accurate and timely manner
  • Communicates readily with Supervisor, case managers and coordinator assistant on programmatic, agency interpersonal, and significant client information
  • Prepares monthly reports in a timely manner as requested by supervisor
  • Serves as an advocate for the clients
  • Reports any emerging trends or unusual situations to supervisor
  • Facilitates admission into program and/or referral (e.g., inpatients treatment, mental health counseling) to appropriate services to assist client

• Computer and Microsoft Office proficiency required
• Case manager experience preferred
• Strong data/analytics background preferred