Eligibility Specialist

Job Title: Eligibility Specialist

Classification: Full Time/ Non-Exempt

Reports to: Front Office Manager

Rate: $15-18 per hour

Summary: Eligibility Specialist provides enrollment assistance for eligible health center patients into affordable health insurance coverage through the Health Insurance Marketplaces, Medicaid, and the Children’s Health Insurance program and determines patient’s eligibility to benefit from the clinic sliding fee scale. Individual will also be available to assist with screening individuals for CBWF’s Patient Ancillary Assistance Program (PAAP).

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.
• Verifies patient demographic information.
• Communicate effectively in writing, including the preparation of administrative, technical and statistical reports.

Additional Expectations:

• Learn and utilize EMR.
• Serves as back up to front office and operator.
• All other duties as assigned.

Qualifications/Experience:

• 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.