Description
Qualifications
Ability to engage patients in conversations and planning regarding their finances and related life impacts. Increase appropriate health insurance coverage and access to quality primary care, dental, vision and behavioral health. This position requires the candidate to conduct focused outreach to educate and assist patients and community members navigate the enrollment process for health insurance coverage (Medi-Cal and/or Covered CA) and health care assistance programs for the uninsured. The specialist works to increase health care access and coordination; insurance coverage and continuity by effectively communicating with patients, clinical and operational departments, and health insurance/health care assistance programs. Assists patients with communication to health options and health center processes. Bilingual in Spanish preferred but not required. Must have a clear CA DMV driving record and have a valid driver's license. Work Experience
Minimum two (2) years experience in medical business office, coding or billing experience in physician's office, FQHC, Ambulatory surgery center, hospital or similar medical facility. Education
Bachelor's degree preferred. Alternatively, 2-5 years of related experience in a medical field required.
Certified Enrollment Counselor (CEC) Certification must be obtained within 90 days of hire and maintained while in this position. Skills
Able to provide enrollment assistance. Must understand and be able to discuss with patients' basic financial problems (debt, collections, payment plans, etc.). Examples of Duties Helping patients understand their insurance coverage. Assist the Clinic Supervisor to conduct educational activities in the service area to raise awareness about insurance coverage options. Working with patients and billing department to create payment plans. Review an ongoing aging report for patient balances 180+ days and routinely reach out by telephone to facilitate payment Work with administrative staff on following policies of patient discharges. Responsible for assisting patients by phone, and may at times have in-person assistance, with questions regarding their accounts. Navigate electronic patient portals such as, Medi-Cal, Presumptive Medi-Cal, FPACT, EWC, CDP, Health Families, Covered CA, etc. Provide benefits application assistance and follow-up to help ensure patient follow through and identify and remove barriers to access. Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken. Maintain knowledge and expertise in eligibility, enrollment, program specifications, and health center payment options to better assist uninsured patients. Submit monthly statistical data to the Clinic Supervisor and other report owners in a timely manner. Resolve patients' service or billing complaints by performing activities such as requesting patient refunds or write-off requests as deemed appropriate by department standards. Educate community members and organizations of the services offered by the Health Center. Participates in periodic evaluation of processes and activities for patient outreach and enrollment strategies. Additional Responsibilities Supports and contributes to efforts to maintain and improve client satisfaction in all aspects of health care delivery. Participates in outreach activities such as health fairs/events when needed. Assists with interpreting for non English-speaking clients if sufficiently proficient in the client's language. Identify and accurately refer patients to appropriate community resources which may address the patients' additional health and social needs. Follows confidentiality requirements and implements HIPPA requirements. Arrange for debt repayment or establish repayment schedules, based on customers' financial situations. Schedules, educates, registers, verifies and estimates services for the patient, updates insurance and demographic information. Locate and notify customers of delinquent accounts by telephone. Advise customers of necessary actions and strategies for debt repayment. Persuade customers to pay amounts due on accounts and/or NSF checks Confer with customers by telephone or in person to determine reasons for overdue payments and to review the terms of service Locate and monitor overdue accounts, using computers and a variety of automated systems. Answer customer questions regarding problems with their accounts. Internal go-to person for questions from staff and patients regarding insurance, payments, co-pays, etc Tools & Technology
Tools : Calculators or accessories; Photocopiers; Scanners; Faxing equipment; Computers and Keyboards; Telephones
Technology : Data software - NextGen; Microsoft Office programs; Electronic Mail - Microsoft Outlook, Navigating and searching websites Knowledge Clerical; Customer and Personal Service; Mathematics; Computers and Electronics; Economics and Accounting; Medical Billing Terminology, Interventions, Assessment, and Relationship building. Overall knowledge of the revenue cycle process, registration, insurance verification, precertification, billing compliance, payer contracts, patient estimation, financial assistance. Abilities
Oral Comprehension; Oral Expression; Written Comprehension; Written Expression; Problem Sensitivity; Deductive Reasoning; Inductive Reasoning; Near Vision; Speech Clarity; Speech Recognition Work Activities
Communicating with Supervisors, Peers, or Subordinates; Getting Information; Interacting with Computers; Performing Administrative Activities; Making Decisions and Solving Problems; Organizing, Planning, and Prioritizing Work; Communicating with Persons Outside Organization; Establishing and Maintaining Interpersonal Relationships; Documenting/Recording Information Work Styles
Integrity; Empathetic, Dependability; Attention to Detail; Cooperation; Independence; Initiative; Self Control; Adaptability/Flexibility; Concern for Others; Stress Tolerance Work Context
Physical Demands:
The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential function of the job, with or without accommodation. Prospective employees must complete a pre-employment medical exam (Occupational Group IV) which will measure the ability to: See well enough to read fine print and view a computer screen; speak and hear well enough to understand, respond, and communicate clearly in person and on the telephone; independent body mobility sufficient to stand, sit, walk, lift or move, stoop, and bend to access the work environment and a standard office environment; manual dexterity and sufficient use of hands, arms and shoulders to repetitively operate a keyboard and to write; and the ability to sit or walk for prolonged periods of time. Will be required to be on telephone calls for longer than normal periods Occasionally may be required to lift/move or assist in lifting/moving up to 50lbs. Reasonable accommodation may be made for some of these physical demands for otherwise qualified individuals who require and request such accommodation.
Work Environment : Position will work from clinic but occasionally may travel to designated locations as needed.
Qualifications
Ability to engage patients in conversations and planning regarding their finances and related life impacts. Increase appropriate health insurance coverage and access to quality primary care, dental, vision and behavioral health. This position requires the candidate to conduct focused outreach to educate and assist patients and community members navigate the enrollment process for health insurance coverage (Medi-Cal and/or Covered CA) and health care assistance programs for the uninsured. The specialist works to increase health care access and coordination; insurance coverage and continuity by effectively communicating with patients, clinical and operational departments, and health insurance/health care assistance programs. Assists patients with communication to health options and health center processes. Bilingual in Spanish preferred but not required. Must have a clear CA DMV driving record and have a valid driver's license. Work Experience
Minimum two (2) years experience in medical business office, coding or billing experience in physician's office, FQHC, Ambulatory surgery center, hospital or similar medical facility. Education
Bachelor's degree preferred. Alternatively, 2-5 years of related experience in a medical field required.
Certified Enrollment Counselor (CEC) Certification must be obtained within 90 days of hire and maintained while in this position. Skills
Able to provide enrollment assistance. Must understand and be able to discuss with patients' basic financial problems (debt, collections, payment plans, etc.). Examples of Duties Helping patients understand their insurance coverage. Assist the Clinic Supervisor to conduct educational activities in the service area to raise awareness about insurance coverage options. Working with patients and billing department to create payment plans. Review an ongoing aging report for patient balances 180+ days and routinely reach out by telephone to facilitate payment Work with administrative staff on following policies of patient discharges. Responsible for assisting patients by phone, and may at times have in-person assistance, with questions regarding their accounts. Navigate electronic patient portals such as, Medi-Cal, Presumptive Medi-Cal, FPACT, EWC, CDP, Health Families, Covered CA, etc. Provide benefits application assistance and follow-up to help ensure patient follow through and identify and remove barriers to access. Keep records of customer interactions or transactions, recording details of inquiries, complaints, or comments, as well as actions taken. Maintain knowledge and expertise in eligibility, enrollment, program specifications, and health center payment options to better assist uninsured patients. Submit monthly statistical data to the Clinic Supervisor and other report owners in a timely manner. Resolve patients' service or billing complaints by performing activities such as requesting patient refunds or write-off requests as deemed appropriate by department standards. Educate community members and organizations of the services offered by the Health Center. Participates in periodic evaluation of processes and activities for patient outreach and enrollment strategies. Additional Responsibilities Supports and contributes to efforts to maintain and improve client satisfaction in all aspects of health care delivery. Participates in outreach activities such as health fairs/events when needed. Assists with interpreting for non English-speaking clients if sufficiently proficient in the client's language. Identify and accurately refer patients to appropriate community resources which may address the patients' additional health and social needs. Follows confidentiality requirements and implements HIPPA requirements. Arrange for debt repayment or establish repayment schedules, based on customers' financial situations. Schedules, educates, registers, verifies and estimates services for the patient, updates insurance and demographic information. Locate and notify customers of delinquent accounts by telephone. Advise customers of necessary actions and strategies for debt repayment. Persuade customers to pay amounts due on accounts and/or NSF checks Confer with customers by telephone or in person to determine reasons for overdue payments and to review the terms of service Locate and monitor overdue accounts, using computers and a variety of automated systems. Answer customer questions regarding problems with their accounts. Internal go-to person for questions from staff and patients regarding insurance, payments, co-pays, etc Tools & Technology
Tools : Calculators or accessories; Photocopiers; Scanners; Faxing equipment; Computers and Keyboards; Telephones
Technology : Data software - NextGen; Microsoft Office programs; Electronic Mail - Microsoft Outlook, Navigating and searching websites Knowledge Clerical; Customer and Personal Service; Mathematics; Computers and Electronics; Economics and Accounting; Medical Billing Terminology, Interventions, Assessment, and Relationship building. Overall knowledge of the revenue cycle process, registration, insurance verification, precertification, billing compliance, payer contracts, patient estimation, financial assistance. Abilities
Oral Comprehension; Oral Expression; Written Comprehension; Written Expression; Problem Sensitivity; Deductive Reasoning; Inductive Reasoning; Near Vision; Speech Clarity; Speech Recognition Work Activities
Communicating with Supervisors, Peers, or Subordinates; Getting Information; Interacting with Computers; Performing Administrative Activities; Making Decisions and Solving Problems; Organizing, Planning, and Prioritizing Work; Communicating with Persons Outside Organization; Establishing and Maintaining Interpersonal Relationships; Documenting/Recording Information Work Styles
Integrity; Empathetic, Dependability; Attention to Detail; Cooperation; Independence; Initiative; Self Control; Adaptability/Flexibility; Concern for Others; Stress Tolerance Work Context
Physical Demands:
The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential function of the job, with or without accommodation. Prospective employees must complete a pre-employment medical exam (Occupational Group IV) which will measure the ability to: See well enough to read fine print and view a computer screen; speak and hear well enough to understand, respond, and communicate clearly in person and on the telephone; independent body mobility sufficient to stand, sit, walk, lift or move, stoop, and bend to access the work environment and a standard office environment; manual dexterity and sufficient use of hands, arms and shoulders to repetitively operate a keyboard and to write; and the ability to sit or walk for prolonged periods of time. Will be required to be on telephone calls for longer than normal periods Occasionally may be required to lift/move or assist in lifting/moving up to 50lbs. Reasonable accommodation may be made for some of these physical demands for otherwise qualified individuals who require and request such accommodation.
Work Environment : Position will work from clinic but occasionally may travel to designated locations as needed.