Eligibility and Enrollment Specialist - 7D - Spanish Req.
Native American Health Center, Oakland, CA, United States
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
Position Summary 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).
Duties And Responsibilities
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 OneEapp/CalHeers/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 needed for the operations and functions of the Member Services Department.
Maintain patient insurance data base rolls by proactively tracking expiration dates, Primary Care assignments, and pending statuses.
Conduct direct outreach to patients due for re-newel applications of insurance programs to maintain retention of coverage.
Meet regularly with the Director, Member Services to discuss patient eligibility problems and/or other issues that are, or may, affect Member Services or the ability to provide high quality care.
Provide back-up for Patient Services Coordinators, possibly during Evening and Saturday clinics, as requested by direct supervisor. Follow all NAHC registration, check-in, and payment procedures of the Member Services Department.
Assist the Billing department in resolving billing problems, as requested by direct Supervisor.
Assist Director, Member Services with staff trainings of States programs, eligibility, benefits, and enrollment processes.
Participate in Saturday clinics and after-hour clinics, on a rotating basis, as assigned by Supervisor.
Attend staff and departmental meetings, as well as special training sessions related to new eligibility criteria for payer programs – when requested by direct supervisor.
Participate in special NAHC internal committees and task forces, as appropriate – including in internal Continuous Quality Improvement efforts and on internal Continuous Quality Improvement teams.
Participate in community outreach activities, agency advocacy, and serve on ad hoc committees, as requested by direct supervisor.
Assist with language translation as needed for healthcare services.
Follow clinic policies and procedures, including maintenance of client confidentiality under HIPAA privacy rules to ensure that the principles of NAHC
Member Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe member practices.
Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well the safety of others.
Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
Quality Improvement: Actively participate in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards, when assigned.
HIPAA: Keep all protected health information (PHI) confidential and abide by HIPAA policies for the release and disclosure of any PHI. Will report unauthorized use of disclosure of PHI immediately, to supervisor or HIPAA security officer.
Work well under pressure, meet multiple and often competing deadlines.
At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.
Other duties as assigned by Supervisor.
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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
Position Summary 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).
Duties And Responsibilities
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 OneEapp/CalHeers/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 needed for the operations and functions of the Member Services Department.
Maintain patient insurance data base rolls by proactively tracking expiration dates, Primary Care assignments, and pending statuses.
Conduct direct outreach to patients due for re-newel applications of insurance programs to maintain retention of coverage.
Meet regularly with the Director, Member Services to discuss patient eligibility problems and/or other issues that are, or may, affect Member Services or the ability to provide high quality care.
Provide back-up for Patient Services Coordinators, possibly during Evening and Saturday clinics, as requested by direct supervisor. Follow all NAHC registration, check-in, and payment procedures of the Member Services Department.
Assist the Billing department in resolving billing problems, as requested by direct Supervisor.
Assist Director, Member Services with staff trainings of States programs, eligibility, benefits, and enrollment processes.
Participate in Saturday clinics and after-hour clinics, on a rotating basis, as assigned by Supervisor.
Attend staff and departmental meetings, as well as special training sessions related to new eligibility criteria for payer programs – when requested by direct supervisor.
Participate in special NAHC internal committees and task forces, as appropriate – including in internal Continuous Quality Improvement efforts and on internal Continuous Quality Improvement teams.
Participate in community outreach activities, agency advocacy, and serve on ad hoc committees, as requested by direct supervisor.
Assist with language translation as needed for healthcare services.
Follow clinic policies and procedures, including maintenance of client confidentiality under HIPAA privacy rules to ensure that the principles of NAHC
Member Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe member practices.
Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well the safety of others.
Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
Quality Improvement: Actively participate in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards, when assigned.
HIPAA: Keep all protected health information (PHI) confidential and abide by HIPAA policies for the release and disclosure of any PHI. Will report unauthorized use of disclosure of PHI immediately, to supervisor or HIPAA security officer.
Work well under pressure, meet multiple and often competing deadlines.
At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.
Other duties as assigned by Supervisor.
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