Patient Eligibility Specialist

2 months ago

Pasadena, United States MyCHN Full time

Are you a value-driven and compassionate individual that believes in providing quality care that has positive effect on our communities? At Community Health Network, we are driven to create extraordinary experiences for our patients and employees. Our objective is to provide opportunities that develop and grow careers in a team-oriented environment focused on patient care

Job Summary:

The Patient Eligibility Specialist [PES] is dedicated to the Center's mission to provide health care to all people without prejudice, in a caring manner, regardless of their ability to pay. The vision of SFACHN is to be the leader in providing quality services and programs which meet or exceed the expectations of our patients. The values of the Center are transparency, empathy, quality, and value.

The Patient Eligibility Specialist [PES] determines eligibility and performs various enrollment and disenrollment processes for Center's approved programs (Title V, PHC/EPHC, Family Planning, etc.) aligning with policies guidelines to ensure compliance. The PES is responsible for reviewing applicants' documents to verify their eligibility for qualifying for various organization programs and extended needs. The PES is expected to perform tasks with greater difficulty and those of an escalated nature. This position requires a strong focus on member and client retention through accurate and timely resolution of issues. The PES should be able to verify and assist in gap coverage for insured patients and will partner cross-functionally with various operational business units (dental, medical, behavior health, etc.) while supporting departmental objectives within company and regulatory guidelines.

Duties and Responsibilities:

Customer Service

  • Provides high level of customer service while maintain patient confidentially and adhere to SFACHN policy's when releasing protected health information [PHI] throughout all interactions with patients, patient's families, community partners, and fellow co-workers
  • Assist to resolve patient concerns by using critical thinking and problem-solving
  • skills; then routing the higher concerns to the appropriate management
  • Assist with determining best practices and standardized procedures. Identifying task for improvement. Assist with training/coaching/praising Patient Eligibility Specialist
Patient Navigation
  • Must attend training and get certified as a Medicaid/CHIP navigator through the Community Partner Program. Evaluates the Centers approved programs, and assure the Center adheres to all policies and changes to any procedures and performs training to staff on an as needed basis
Patient Eligibility
  • Prepares, processes, and maintains new and existing patient eligibility enrollments and dis-enrollments. Staying knowledgeable with approved programs for routine inquiries from prospective and current patients
  • Determines patient's insurance benefits and aligns patients with Center's established programs. Upon patient's evaluation of coverage, the enrollment specialist will recommend the patient to other qualified programs that could fill in the gap(s) of coverage
  • Serves and protects the Center by adhering to professional standards, facility policies and procedures, federal, state, and local requirements, and PCMH standards. Collects all required documentation from patients and family to qualify to services and assures all documentation is properly imported into patient's chart
  • Other duties as assigned
Required Skills/Abilities:
  • Ability to work with people of all socioeconomic levels
  • Ability to respond effectively to the most sensitive inquiries or complaints
  • Consumer advocate for quality health care and services
  • Familiarity with office equipment: computer keyboarding, calculator, photocopiers, and faxes
  • Ability to communicate clearly and effectively
  • Strong team player with a focus on collaboration
  • Ability to handle multiple projects simultaneously
Preferred Skills/Abilities:
  • Bilingual in Spanish
Required Education and Experience:
  • 1 year of administrative health care experience
  • High school diploma or GED equivalent
  • Clerical or front office experience in a medical or dental facility
Preferred Education and Experience:
  • None
Supervision Responsibilities:
  • None
Physical Requirements
  • Frequently required to sit
  • Frequently required to talk and stand
  • Frequently required to utilize hand and finger dexterity
  • The employee must occasionally lift and/or move up to 50 pounds
  • Specific frequently vision abilities required by this job include: Close vision, Color vision, Peripheral vision, Depth perception, and Ability to adjust focus
Work Environment:
  • BLOODBORNE PATHOGENS EXPOSURE LEVEL: 3 (LOW)
  • Noise Level:Moderate

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