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Eligibility Specialist, I
2 months ago
POSITION SUMMARY:
Assist clients with registration and program eligibility paperwork and provide follow-up support on eligibility. Assist patients with appointment scheduling. Cross train for all patient access responsibilities.
DUTIES AND RESPONSIBILITIES:
- Interviews patients or authorized representative to gather information while determining eligibility for San José Clinic services.
- Spend most of the work day reviewing, and organizing files and papers. Organization and attention to detail are extremely important.
- Obtains, verifies, and calculates income and resources to determine patient sliding-fee level eligibility.
- Ensure program eligibility forms are completed as required.
- Provide clients with list of required eligibility documents.
- Provide information and educate patients on clinic procedures relative to contributions for San José Clinic services.
- Performs data entry of eligible clients into electronic system.
- Obtain client information by answering telephone calls, interviewing clients and verifying information. Contacting customers will be necessary to gather necessary information and explain outcomes.
- Scans all necessary demographic, financial information, consents and other missing documents required for registration and to properly determine San José Clinic eligibility.
- Monitor pending applications to ensure they are completed on a timely basis. Follow up with patients daily to close out pending applications.
- Respond to client email inquiries, and other non-phone inquiries/communications.
- Refer patients to community service organizations as needed.
- Coordinate with patient access team members regarding eligibility status updates.
- Manages a high volume of applications and data entry daily. Enters all data into Athena accurately and in the required timeframe.
- Complete monthly reporting and maintain eligibility status records in Excel.
- Maintain up to date and orderly eligibility files.
- Attends community outreach events as assigned.
- Cross train for all patient access responsibilities.
- Attention to detail and a positive attitude are keys to success in this position.
- Prioritizes and completes all work in an accurate, effective and efficient manner.
- Follows all HIPAA and OSHA guidelines and regulations, including assisting HIPAA and OSHA Officers in ensuring compliance.
- Maintains confidentiality of patient information/records at all times
- Maintains established San José Clinic policies, procedures, objectives, quality assurance, safety, environmental and infection control.
- Implements job responsibilities in a manner that is consistent with the San José Clinic Mission and Code of Conduct and is supportive of San José Clinic cultural diversity objectives.
- Build and maintain positive working relationships with team members, other departmental employees, and the public utilizing principles of effective customer service.
- Performs other duties as assigned
QUALIFICATIONS, EDUCATION AND EXPERIENCE:
- High school diploma or equivalency; college degree preferred.
- Bilingual English/Spanish required
- Minimum one to three years experience in a medical office including at least one year of relative experience.
- Must be comfortable working with financial documents (tax returns, pay stubs, etc.) and evaluating them relative to program eligibility
- Proficiently use the computer medical management software entering and updating patient information as required, including, daily input of patient and insurance information.
- Proficiently use the electronic medical records software entering and updating patient information as required, including, daily input of patient and insurance information.
- Excellent communication skills
- Knowledge of standard office policies and procedures.
- Knowledge of insurance eligibility requirements.
- Skill in organizing time and managing multiple demands.
- Skill in dealing with patients and visitors as well as other staff members.
- Ability to work independently and use good judgment in work prioritization
- Ability to complete difficult/complex tasks.
- Ability to follow oral and written instructions.
PHYSICAL REQUIREMENTS:
- Ability to sit, stand, bend and stoop for (long) periods of time.
- Ability to exert up to 50 pounds of force occasionally/frequently.
- Ability to work in a stressful environment.
- Ability to respond to emergency/crisis situations.
- Exposure to noise.
- Exposure to blood and/or body fluids.