Job Description
Job Title: Financial Eligibility Specialist
Job Summary:
The Financial Eligibility Specialist determines applicant eligibility for third-party reimbursement, processes data for admission of new patients into health services, ensures proper insurance billing coding, and handles inquiries from prospective applicants and patients. Responsibilities include conducting fee scale and insurance eligibility assessments, implementing the Ryan White Cap, linking patients to eligible insurance and assistance programs, and applying fee scales to other payer sources. The specialist also refers clients to medical case managers for additional assistance, ensures compliance with Maryland insurance programs and Chase Brexton policies, and maintains up-to-date eligibility files. They provide comprehensive monthly patient statistics and metrics and respond to billing inquiries related to Sliding Fee charges.
Education and/or Experience:
- High School Diploma or GED.
- Certified Application Counselor designation required within three (3) months of hire.
- Minimum three (3) years of experience with insurance verification and/or sliding fee scale determination.
- Training or background in ICD-A/CPT codes preferred.
- Knowledge of insurance and billing practices preferred.
Major Duties and Responsibilities:
- Analytical and Critical Thinking:
- Conduct fee scale and insurance eligibility assessments following program-specific procedures and guidelines.
- Calculate and implement the Ryan White Cap.
- Review relevant reports and link patients to eligible insurance and assistance programs.
- Problem Solving and Decision Making:
- Apply client fee scales appropriately to other payer sources such as Medicare, Medicaid, and third-party insurance.
- Refer clients to medical case managers for additional assistance as needed.
- Compliance, Policy, and Procedure:
- Demonstrate working knowledge of Maryland insurance programs, Chase Brexton policies, and procedures.
- Meet quality and productivity standards set by the site Director of Operations or their designee.
- Workplace Computers and Equipment:
- Register clients into CPS and complete Case Management visit notes.
- Checking, Examining, and Recording:
- Complete all necessary paperwork accurately.
- Maintain orderly eligibility files.
- Provide comprehensive monthly reporting of patient statistics and metrics.
- Planning and Organizing:
- Conduct renewal eligibility assessments as required.
- Participate in workgroups and special projects as assigned.
- Patient Focus:
- Confirm eligibility appointments with clients.
- Schedule initial service appointments post-eligibility determination.
- Provide clients with a list of required eligibility documentation.
- Refer patients to new Chase Brexton services based on treatment needs.
Skills and Abilities:
- Ability to become a Certified Application Counselor and complete enrollments through the Maryland Health Benefits Exchange within three (3) months of hire.
- Understanding of bookkeeping and accounting terminology.
- Proficiency in operating computers and other office machines.
- Cultural competence and ability to provide individualized care to patients of diverse backgrounds.
- Bilingualism preferred.
- Ability to work under pressure and take responsibility.