Eligibility Specialist

Responsibilities

• Complete online training courses to become a Certified Application Specialist upon hire.
• Determine patient’s eligibility and assist in applying for health insurance through the Marketplace.
• Educate potential new patients on available services and assist in new patient enrollment.
• Completes sliding fee scale packet on patients to determine eligibility for service discounts.
• Maintains all appropriate documentation of patient’s eligibility, to include financial documents, scan and place in patient folder, and update as required.
• Contact patients utilizing sliding fee scale to remind them to update eligibility packet and secure updated financial documents.
• Successfully complete internal trainings to include cultural competency, health literacy, and privacy and security standards.
• Verify patient demographic information.
• Communicate effectively in writing, including the preparation of administrative, technical and statistical reports.

Requirements

• Certified Application Counselor- ACA Training or able to become certified
• Understanding of insurance and the marketplace.
• Experience in Children’s Health Insurance Program (CHIP) and Medicaid eligibility and enrollment.
• PREFERRED: BA in social service field or marketing, experience may be substituted
• Experience working in a clinic and/or social service organization.
• Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers and other funding sources.

Time/Physical Requirements

Monday-Friday, 8:00am-5:00pm/40 hours per week
Some evening and weekend activities may require flexing schedule
Tasks occur in both medical office, clinic setting, and community
Able to lift 25lbs and perform normal duties associated in a clinic and office setting.