Certified Eligibility Specialist

San Ysidro Health•San Diego, CA

4d•$26 - $33

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. The role assists individuals and families in obtaining and maintaining health care coverage by helping with applications, renewals, follow-up, and referrals. The specialist also conducts educational activities at clinic sites and community locations, maintains records and reports, and provides responsive service to patients, employees, agencies, and the public. The position requires travel to other locations within San Diego County and may include evening or weekend work.

Requirements

High school diploma or GED equivalent required.
At least one year of eligibility insurance or billing experience; related education may substitute for experience.
Excellent oral and written communication skills.
Bilingual English/Spanish required.
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.
At least good computer and tablet literacy, including internet navigation and research skills.
Ability to pass the Covered California criminal background check and Certified Enrollment Counselor (CEC) exam, and pass the SYH Eligibility competency exam within a 90-day probationary period.
Reliable transportation and ability to travel to events and other locations within San Diego County.
Ability to work effectively with people from different cultures and socioeconomic backgrounds; cultural sensitivity and respect for diversity.
Service orientation, self-direction, strong organization and prioritization skills, ability to complete a high volume of work within strict deadlines, and ability to provide prompt, efficient, responsive customer service.
Ability to lift up to 30 pounds, stand and walk frequently indoors and outdoors, and set up and take down event equipment.

Nice To Haves

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

Responsibilities

Assist individuals and families with applying for and retaining health coverage by collecting personal and demographic information, determining eligibility, assessing needs, and explaining coverage options.
Upload and submit verification documents and completed applications.
Complete and submit health coverage applications, including presumptive eligibility and gateway applications; follow up with patients and government agencies to support timely processing and completion of applications and 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.
Facilitate referrals to SYH and community resources for additional needs and complex issues.
Maintain accurate records, prepare statistical reports and patient/client correspondence, and submit monthly reports by the first of each month.
Provide accurate, complete, and current information and courteous, efficient service 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, including seniors and individuals with disabilities, to prevent coverage lapses.
Conduct patient engagement events and individual or group educational activities at SYH clinic sites and community locations, covering SYH services and programs, public health assistance, health insurance options, voter registration, and relevant policy issues.
Support the Patient Service and Eligibility Supervisor with on-site training for new staff using established procedures and training templates.
Comply with departmental, organizational, and government policies and procedures.
Attend all in-service meetings and trainings.
Provide CES coverage as needed.
Perform other related duties as assigned or requested.