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2 days ago
As 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 Responsibilities- Advise patients of their financial obligations and collect deposits, co-payments, and pre-payments for services.
- Assist patients in resolving billing and collection issues with their hospital account(s).
- Review and analyze patient account information, payment history, and verification of insurance or other coverage information.
- Assist patients in submitting necessary information to billing or setting up payment arrangements.
- Determine eligibility for third-party payment sources according to established policies and procedures.
- Update patient financial information in the hospital/clinic information system and enroll applications and supporting documentation to the appropriate agencies and/or departments.
- Inform and advise medical providers of patients' financial status and maintain open communication with physicians and clinical staff.
- Interpret laws and regulations of Federal, State, and County programs and advise patients of eligibility requirements and their rights and obligations.
- Plan, organize, and prioritize workload and process information at a speed necessary for successful job performance.
- Provide training for ECs and ES I/II staff for the purposes of registration and eligibility.
- Register and interview patients to obtain demographic and financial information necessary for patient identification, billing, and collection of accounts.
- Review and investigate health care coverage and policy limitations to update patient information for long-term care, short-term treatment, and other related programs.
- Review difficult or unusual cases with Supervisor or Lead Worker for clarification and to ensure accuracy in assessing patient financial circumstances and eligibility determinations.
- Stay informed of both internal and external programs, research, review, interpret, and follow all relevant policies, procedures, regulations, guidelines, and laws, and attend mandatory trainings.
- 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 full-time 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.
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