Eligibility Specialist I, Per Diem, Varied Shift, 8hours
3 hours ago
Under general supervision, the Eligibility Specialist I performs a variety of hospital admitting, discharge, registration and financial screening functions, with the objective of determining eligibility for medical coverage under the terms of various private and public health care and financial services assistance programs.
This may include programs such as Medicare, Medi-Cal, Breast and Cervical Cancer diagnostic and treatment programs, Managed Care Plans, Medi-Cal Managed Care Programs, private insurance and numerous other health plans and programs; and other related duties as required.
The Eligibility Specialist I is located in the Patient Business Services Department at Highland Hospital Emergency, Admitting and Outpatient Registration Departments, Fairmont Hospital Outpatient Registration and Admitting Department and in the Ambulatory Care Services Departments at the freestanding Clinics.
Staff may be required to work at alternate locations as necessary.
This classification series is flexibly staffed wherein a new employee is hired as an ES I and after 12 months of satisfactory performance an evaluation of the full scope of duties is upgraded to an ES II.
Performs related duties as required.
Key Responsibilities- Advises patient/guarantor of financial obligations; collects and processes deposits, co-payments and pre-payments for services.
- Assists patients in resolving issues with billing and collection of their hospital account(s).
- Assists with special projects and performs related clerical and administrative duties as required.
- Contacts and consults with patient, guarantor, or other representative, as well as with various County, State, Federal or other outside agencies regarding patient matters related to eligibility for health care services.
- Determines eligibility for a third party payment source according to established policies and procedures including private health plans, Victims of Crimes, Workers Compensation and lawsuit settlements.
- Immediately updates all patient financial information in the hospital/clinic information system and enrolls all applications and supporting documentation to the appropriate agencies and/or departments within prescribed timelines, to ensure timely and accurate submission of claims needed to maximize reimbursement to the Medical Center.
- Informs and advises medical providers of patients financial status and maintains open communication with Physicians and clinical staff to ensure timely notification of any health conditions or diagnosis that could qualify patient for programs to assist them with their healthcare costs.
- Interprets laws and regulations of Federal, State and County programs and advises patient of eligibility requirements, as well as their rights and obligations in receiving financial services from these programs.
- Assists patients in completing applications and forms when necessary and reviews for accuracy and completion.
- Plans, organizes and prioritizes workload and processes information at a speed necessary for successful job performance.
- Provides training for ECs, ES I/IIs for the purposes of registration and eligibility.
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Oakland, California, United States Alameda Health System Full timeJob SummaryAs an Eligibility Specialist I, you will play a crucial role in determining patient eligibility for medical coverage under various private and public health care and financial services assistance programs. This includes programs such as Medicare, Medi-Cal, and private insurance, among others.Key ResponsibilitiesAdvise patients of their financial...
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