Eligibility Review Specialist

1 week ago

Hayward California, United States Tiburcio Vasquez Health Center Full time
Position Overview:

The Eligibility Review Specialist is tasked with overseeing the continuous assessment of program eligibility for all patients. This role involves processing new patient registrations and conducting thorough evaluations of existing patients to ensure accurate eligibility determinations across various payer sources.

Key Responsibilities:

  • Conducts daily administrative tasks and general office duties, including word processing, filing, and data entry.
  • Welcomes new patients with respect, conducting interviews to determine eligibility for services and payment methods.
  • Maintains strict confidentiality and adheres to clinic policies regarding safety and security.
  • Completes patient registration forms, verifies financial information, and creates patient accounts in the health center's system.
  • Initiates new patient medical records and maintains logs of medical record numbers.
  • Explains available services, billing policies, and patient rights.
  • Advises patients on community resources for financial assistance and makes appropriate referrals.
  • Performs ongoing eligibility reviews for established patients as per health center policies.
  • Communicates with patients via mail or phone to verify financial status or address.
  • Ensures compliance with all funding sources and regulations.
  • Treats all patients with dignity and respects their confidentiality.
  • Collaborates with the Financial Eligibility Coordinator and Registration Services Coordinator for accurate billing and reporting.
  • Handles patient complaints with diplomacy and refers them to designated personnel as necessary.
  • May require travel between sites and flexible working hours.
  • Participates in the successful implementation of EHR/EPM systems.
  • Performs additional duties as needed.

Qualifications:

  • High school diploma or GED required.
  • Bilingual in English and Spanish is essential.
  • Minimum one year of experience in third-party billing and state-funded programs.
  • At least two years of clerical experience involving diverse responsibilities.

Skills and Attributes:

  • Strong understanding of confidentiality and HIPAA standards.
  • Excellent customer service and interpersonal skills.
  • Ability to work under pressure with minimal supervision.
  • Detail-oriented with proficiency in modern office procedures.
  • Proficient in computer skills, including email and internet usage.
  • Willingness to learn new data systems and work flexible hours.

Benefits:

We offer a comprehensive benefits package that includes medical, dental, and vision coverage, generous paid leave, retirement plans with employer matching, tuition reimbursement, and more.

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