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Patient Eligibility Coordinator

3 months ago

Kyle, Texas, United States CommuniCare Health Center Full time
Position Overview
As a vital member of the CommuniCare Health Center team, the Patient Eligibility Coordinator is dedicated to delivering outstanding service to all clients. This role involves managing patient accounts effectively and assisting individuals in understanding their account details.

The coordinator plays a crucial role in determining client eligibility for enrollment in various health coverage options, including Qualified Health Plans (QHP) through the Federal Marketplace, Medicaid/CHIP, and other health initiatives.

This position requires maintaining the confidentiality of all patient information.

KEY RESPONSIBILITIES:

  • Handles the registration of new patients, updates their information, and performs data entry of demographic details. Verifies third-party insurance coverage, including co-pays, deductibles, and co-insurance. Ensures the accurate activation of health plans and programs while documenting special notes in patient management software; assists patients with the registration process.
  • Conducts thorough eligibility assessments for patients seeking various programs offered by the Center; assists with application processes for specially funded programs; accurately assigns clients to appropriate programs based on funding criteria; refers potentially eligible Medicaid patients to the State Medicaid representative and/or facilitates their enrollment. Follows up on eligibility processes by contacting patients for additional information and reaching out to funding sources for status updates.
  • Prepares for upcoming clinic sessions by reviewing and confirming patient appointments, noting payment alerts and balances, obtaining current insurance details, updating income verification, pre-registering patients, and screening them for program eligibility.
  • Maintains up-to-date knowledge and expertise in eligibility, enrollment, and program specifications related to the Federal Marketplace and other health coverage options such as Medicaid and CHIP. Adheres to departmental policies and funding source requirements; stays informed about changes in funding regulations.
  • Ensures the security and confidentiality of consumer personal, confidential, and identifiable information in a professional manner, in compliance with the Health Insurance Portability and Accountability Act (HIPAA).
  • Processes credit card transactions, ensuring accurate application of payments to patient accounts. Completes end-of-day reconciliation reports to ensure credit card payments align with practice management records.
  • Provides training support to staff on insurance verification, demographic entry, program eligibility criteria, payment processing, and other related tasks.
  • Delivers exceptional customer service to both internal and external clients. Communicates effectively with clients, support staff, and third-party payers to resolve billing inquiries and concerns regarding charges, payments, adjustments, benefits, and potential refunds. Arranges payment plans with patients when necessary.
  • Performs additional related duties as assigned.

QUALIFICATIONS:
High School diploma or equivalent required.

Minimum of one year of experience in front office operations, including insurance verification and referrals.


Must complete at least 30 hours of training to obtain Consumer Assistance Certification within six months of employment and recertify annually.

Proficient in Word, Excel, Internet/Intranet, and EHR (Electronic Health Record) data entry skills.

Knowledgeable in healthcare billing, including Medicaid, Medicare, and Private Insurance.

Exhibits strong verbal and written communication skills, along with interpersonal and organizational abilities.

Capable of managing multiple tasks with minimal supervision while maintaining attention to detail.

Bilingual (English/Spanish) preferred.

Work hours and locations may vary.

PHYSICAL REQUIREMENTS:

Finger Dexterity:
Ability to use fingers for small movements such as typing or handling small objects.

Communication:
Frequently conveys detailed or important instructions or ideas accurately and clearly.

Auditory:
Able to hear average conversations and receive ordinary information.

Repetitive Motions:
Regularly uses wrists, hands, and fingers.

Visual Acuity:
Normal visual acuity necessary for preparing or inspecting documents and materials.

Physical Activity:
Sedentary work; primarily sitting. May require lifting of files, papers, and equipment weighing up to approximately 25 lbs.