Patient Eligibility Specialist

Position Code: B03N | Salary Grade: D | Non-Exempt | Department: Health Center Operations | Location: Health Centers Union

About the Role

The eligibility specialist works with patients and the public to determine eligibility for various healthcare funding programs under the close supervision of the Outreach and Enrollment Program Manager or Health Center Manager. This role is supportive and responsive to patient needs.

Responsibilities

• Provide accurate and impartial information to patients and the public about health insurance coverage available under the Affordable Care Act.
• Conduct outreach and education activities in clinics, community settings, and door-to-door (as appropriate) on weekdays, weekends, and evenings to meet community needs.
• Explain and assist patients and the public with eligibility determination and application for healthcare financial assistance and/or insurance programs, including Medicaid, Medicare, UNM Care, NM Health Insurance Exchange plans, Title X, BCC, CRC, Title V, and sliding fee discounts.
• Verify insurance eligibility for Medicaid, Medicare, and third-party payors, ensuring documentation acceptance by HSD or other agencies.
• Update patient records in the practice management system, including income and insurance information.
• Provide information to patients and the public about FCCH functions, ensuring customer satisfaction and high-level service.
• Meet and document monthly enrollment quotas for grant reporting.
• Answer telephones, connect callers to appropriate offices or staff, and refer to other agencies when FCCH cannot meet needs.
• Schedule appointments over the telephone and in person using the practice management system and other software.
• Perform other duties as assigned.

Requirements

• High School graduate or GED certificate.
• At least two years of related experience and/or training.
• Bi-lingual (English/Spanish) preferred.
• Obtain and maintain a Presumptive Eligibility Determiner Number within the first 6 months of hire.

Skills

• Comfort working with people one-on-one and giving group presentations.
• Proficiency using the Internet, various software programs, computers, laptops, wireless cards, mobile scanners, and cell phones.
• Strong interpersonal communication skills and ability to establish trust while maintaining professional relationships.
• Basic knowledge of health insurance and health delivery systems.
• Ability to recognize and address barriers, including cultural and language differences.
• Ability to summarize and explain complex information in different ways to meet diverse learning needs.
• Ability to work independently and as part of a team in field and office settings.
• Effective time management and prioritization to meet deadlines.
• Flexibility with schedule, assignments, and multiple tasks.
• Ability to work under supervision and follow detailed instructions.
• Initiative to resolve patient concerns and problems.
• Ability to travel outside the county on a daily basis if needed.
• Knowledge of compliance programs and adherence to laws and regulations.

Working Conditions

• Work is mostly inside an office in a controlled environment, with normal office safety precautions required.
• Position requires travel throughout the Greater Albuquerque metropolitan area.
• Work schedule includes some weekends and evenings.
• Frequent opportunities to relax from physical exertion, change positions, or take breaks from computer tasks.
• Good dexterity for operating personal computers and office equipment; occasional lifting related to office duties.
• Must be able to read computer monitors accurately and communicate clearly for work and safety compliance.