Financial Eligibility Specialist

Major Duties And Responsibilities

• Analytical and Critical Thinking
• Conducts fee scale and insurance eligibility for clients following procedures and guidelines specific to each program.
• Calculate and implement the Ryan White Cap Review relevant reports and follow up to link patients to eligible insurance and/or assistance programs
• Problem Solving and Decision Making
• Ensure that the client’s fee scale is appropriately applied to any other payer source such as Medicare, Medicaid, MADAP, and any other third-party insurance.
• Refer clients to medical case manager should someone be entitled to additional assistance.
• Compliance, Policy, and Procedure
• Working knowledge of all Maryland insurance programs and eligibility guidelines.
• Working knowledge of all Chase Brexton policies and procedures
• Compliance with all expected quality and productivity standards as set by the site Director of Operations, quality team, or their designee.
• Workplace Computers and Equipment
• Register clients into CPS and ability to complete Case Management visit note explaining any referrals or plans
• Checking, Examining, and Recording
• Completes all necessary paperwork. Maintains up-to-date and orderly eligibility files.
• Provides comprehensive monthly reporting of patient statistics and metrics.
• Responding to billing discussions or questions related to Sliding Fee charges
• Planning and Organizing
• Conducts renewal eligibility as required by each program.
• Participation in workgroups and special projects, as assigned.
• Patient Focus
• Confirms eligibility appointments with clients.
• Sets initial service appointments once eligibility has been determined.
• Provides clients with list of required eligibility documentation.
• Refer patients to new Chase Brexton services based on patient treatment needs
• Skills And Abilities
• Must become a Certified Application Counselor and complete enrollments through the Maryland Health Benefits Exchange within three (3) months of hire.
• Required: Ability to understand and practice bookkeeping and accounting terminology
• Required: Ability to operate computers and other office machines
• Cultural competence and the ability to work with providing individualized care that respects and empowers patients of all ages, races, gender identities, religions, sexual orientations, ethnicities, and socioeconomic statuses.
• Providing care that honors, affirms, and supports each patient is at the core of everything we do.
• Bilingual preferred.
• Must be able to take responsibility and work under pressure.

Education And/Or Experience

• High School Diploma or GED.
• Required: Certified Application Counselor designation within three (3) months of hire.
• Required: At least 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.