Certified Eligibility Specialist

San Ysidro Health•San Diego, CA

About The Position

Under the supervision of the Patient Service & Eligibility Supervisor, the Certified Eligibility Specialist provides eligibility education, enrollment navigation, and retention support at patient engagement events to help individuals and families obtain and maintain health care coverage. The role assists with applications, eligibility determinations, verification documents, renewals, and follow-up with patients and government agencies. It also connects patients with SYH and community resources, maintains records and reports, and provides accurate, courteous service to patients, employees, government representatives, outside agencies, and the public. The specialist conducts individual and group engagement and educational activities at SYH clinic sites and community locations. Topics include SYH services and programs, public health assistance, health insurance options, voter registration, and policy issues affecting the community. The role also supports on-site training of new staff and provides CES coverage as needed. The position requires travel to locations within San Diego County and may involve evening or weekend work and physical event setup and takedown.

Requirements

High school diploma or GED equivalent.
At least one year of eligibility insurance or billing experience; related education may substitute for experience.
Pass the Covered California criminal background check and the Certified Enrollment Counselor (CEC) exam and SYH Eligibility competency exam within a 90-day probationary period.
Excellent oral and written communication skills.
Bilingual English/Spanish ability.
Knowledge of local, state, and federal public health assistance programs and their policies and regulations.
Proficiency with Microsoft applications and electronic health data systems, including CalWin and Cal HEERS.
Good computer and tablet literacy, including internet navigation and research skills.
Reliable transportation and ability to travel to events and other locations within San Diego County.
Ability to work some evenings and/or weekends.
Cultural sensitivity and respect for diversity, with the ability to work effectively with people of different cultures and socioeconomic status.
Service orientation, self-direction, strong organization, ability to prioritize and complete a large volume of work within strict deadlines, and prompt, efficient customer service.

Nice To Haves

Bachelor’s degree in a health or human service field.

Responsibilities

Collect personal and demographic information, assess needs, determine eligibility, and provide information about health coverage options.
Assist individuals and families with applying for and retaining health coverage.
Upload and submit verification documents and completed applications, including presumptive eligibility and gateway applications.
Follow up with patients and government agencies to ensure timely processing and completion of applications and required documentation.
Monitor and initiate health coverage redeterminations and renewals.
Complete Medi-Cal Renewal Packages and CCA Renewal Processes, report changes on active accounts, process Medi-Cal Add-Ons, and submit Newborn Referrals.
Refer patients to SYH and community resources to address additional needs and complex issues.
Maintain accurate and thorough records of activities.
Prepare statistical reports and patient/client correspondence, and submit monthly reports by the first of each month.
Provide responsive, high-quality service and accurate, complete, up-to-date information to patients, SYH employees, county representatives, outside agencies, and the public.
Conduct follow-up to help families obtain and retain coverage, with particular attention to high-acuity patients such as seniors and individuals with disabilities.
Conduct individual and group patient engagement events and educational activities at SYH clinics and community locations.
Provide information on SYH services and programs, public health assistance, health insurance options, voter registration, and community-impacting policy issues.
Support the Patient Service and Eligibility Supervisor with on-site training of new staff using established procedures and training templates.
Comply with departmental, organizational, and government policies and procedures.
Attend in-service meetings and trainings.
Provide CES coverage as needed and perform other related duties as assigned or requested.