Eligibility Specialist I, Per Diem, Varied Shift, 8hours Position

3 weeks ago


Oakland, California, United States Alameda Health System Full time

Job Summary: 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.

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).
  • 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.
  • 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.
  • 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.
  • Registers and interviews patients to obtain demographic and financial information necessary for patient identification, billing and collection of accounts.
  • Reviews and investigates health care coverage and policy limitations to update patient information for long term care, short term treatment and/or programs such as Charity, County Medical Services Program (CMSP), Medi-Cal, Family P.A.C.T., Child Health and Disability Program (CHDP), ADAP, and all other related programs.

Requirements:

  • High School diploma or equivalent.
  • Successful completion of the Eligibility Academy/Training Programs and respective examination offered through AHS.
  • Bilingual, where necessary.
  • Demonstrated use of PC and related applications.
  • One-year in the classification of Eligibility Clerk, OR The equivalent of two years fulltime clerical experience which must have included at least one year of experience in a hospital/clinic or related unit involving determination of eligible or credit and collection work for medical assistance through personal interview or increasingly responsible public contact experience which involved processing financial or personal/confidential information, preferably in a medical/hospital setting.


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