Job Summary: The Enrollment Specialist II obtains third party coverage for patients (Inpatient/Outpatient) who have no other means of payment. Ensures that all payment/program possibilities are exhausted. This job approves the patient for JPS Connection and other County, State and/or Federal assistance programs and obtains missing registration items as applicable.

Essential Job Functions & Accountabilities:

1. Interviews clients or authorized representative to gather information while determining eligibility for benefits.
2. Obtains, verifies, and calculates income and resources to determine client’s financial eligibility.
3. Explains available benefit programs, rights and responsibilities and other agency services to applicants/recipients and general public.
4. Conducts timely follow-up on cases and/or accounts which includes making phone calls to applicants/patients to ascertain the potential for eligibility for JPS Connection, other programs, or to obtain missing insurance information or missing registration items.
5. Approves patients for Charity Care, refers completed cases to Health and Human Services Commission (HHSC) for Medicaid and other State or Federal programs, and refer difficult accounts to eligibility team leader and/or management team in accordance with established guidelines.
6. Assists patients in completing program applications and other paperwork.
7. Accurately input and update data and/or coverages. Verify, update, enter detailed case notes, and enter third party insurance plans in the eligibility and hospital computer system when changes occur.
8. Obtains and scans all necessary demographic, financial information, missing registration items, Important Message from Medicare (IMMs), consents and other missing documents required for registration and to properly determine potential program eligibility.
9. Answers phone calls in a timely manner to ensure abandonment rate is maintained at less than 5%.
10. Maintains a minimal error rate and maintains productivity levels as determined by established standards and guidelines.
11. This position is cross trained in all areas of Eligibility & Enrollment.
12. Attends community outreach events as assigned (local travel as required).
13. Job description is not an all-inclusive list of duties and may be subject to change with or without notice. Staff are expected to perform other duties as assigned.