Eligibility and Enrollment Specialist - 7D - Spanish Req

POSITION: Eligibility Specialist
DEPARTMENT: Member Services
LOCATION: Native American Health Center, Inc. (NAHC) – All Sites
Address: 2950/3124 International Blvd., Oakland, CA 94601; 160 Capp Street, SF, CA 94110
WORK HOURS: Full Time, 40 hours per week, 100% FTE
STATUS: Union, Non-Exempt

The Eligibility Specialist (ES) will work as a part of a multi-disciplinary team of individuals who provide high quality patient care. The ES will work in and advanced capacity to identify appropriate funding sources (e.g., Medi-Cal, CHDP, private insurance, sliding scale, and other contracted programs) that may cover the cost of treatments. The ES will directly enroll patients through the County/State databases and will conduct outreach to retain coverage, re-determine eligibility, and re-enrollment of programs and insurances for individuals and families.

The ES will explain program and insurance benefits information to patients and assists patients with accessing services at the Native American Health Center. As the ES deals directly with the public, superior customer service skills, effective communication and advanced knowledge of eligibility and enrollment of multiple insurance programs available to underserved populations is required.

The Native American Health Center is an accredited institution and adheres to the standards of excellence set forth by the Accreditation Association of Ambulatory Health Care (AAAHC) and the Commission of Dental Accreditation (CODA).

• Greet all patients in a courteous and professional manner to create and maintain a welcoming atmosphere.
• Provide patient customer service by scheduling patient appointments appropriately, answering and retuning telephone calls in a timely manner, informing patients of process and procedures to accessing services.
• Proactively manage and “tetris” appointment scheduling to maximize productivity and to fill appointment gaps.
• Conduct patient financial screenings to determine their eligibility for County Medical Services Program (LIHP/ACE);
  Medicare;
  Medi-Cal;
  Healthy Families;
  State Office of Family Planning (SOFP);
  Presumptive Eligibility;
  Alameda Alliance for Health-AAH Family Care; and other payment sources
• Use One Eapp/Cal Heers/Covered CA Portals as a means to determine eligibility and enroll into eligible programs
• Provide Covered CA education on available plans/metal tiers clients are eligible to enroll in.
• Follow all enrollment criteria, eligibility rules/requirements, and maintain certification of any and all Federal, State, County health programs NAHC is required to follow.
• Assist patients with completing forms and applications for various payment programs.
• Register members into NAHC member portal. Provide user support and education on portal functionality.
• Manage NAHC member portal appointment request and member messages.
• Assist patients with completing their Medi-Cal applications; and follow-up with the county’s Medi-Cal worker to ensure approval of applications, during the Medi-cal workers scheduled on site visits.
• Answer inquiries and provide counseling to patients regarding Medi-Cal and Medicare and their managed care systems in a clear and professional manner that ensures their understanding.
• Responsible for entering accurate assigned payer codes in (PMS), entering expiration dates according to guidelines, terminating inactive payer codes, and select appropriate payers codes for services.
• Register patients into the practice management system (PMS) in a manner that ensures accuracy and thoroughness and update patient registration information once per year at minimum, or as information changes. Inform patients of Notice of Privacy Practices and obtain the patients signed acknowledgement statement with at least 90% data accuracy.
• Update patients’ financial information in the practice management system (PMS) in a manner that ensures completeness, accuracy and timeliness; and follow up on patients’ ‘pending statuses’ for payment programs.
• Proactively provide input in developing and maintaining eligibility criteria and procedures consistent with NAHC’s goals and objectives.
• Generate Practice Management reports as…