Certified Eligibility Specialist

San Ysidro Health•Chula Vista, 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. The role assists individuals and families in obtaining and maintaining health care coverage through application support, eligibility guidance, follow-up, renewals, referrals, and community education. The specialist supports patients, SYH employees, county representatives, outside agencies, and the public by providing accurate, current information and courteous, timely service. The position also maintains thorough records, prepares reports and correspondence, assists with staff training, and provides coverage as needed. Travel to other sites within San Diego County and occasional evening or weekend work are required.

Requirements

High school diploma or GED equivalent.
At least one year of eligibility insurance or billing experience; related education may substitute for experience.
Must pass the Covered California criminal background check, 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.
Knowledge of local, state, and federal public health assistance programs and applicable policies and regulations.
Proficiency with Microsoft applications and electronic health data systems, including CalWin and Cal HEERS.
Computer and tablet literacy, including internet navigation and research skills.
Ability to travel to and from events and other locations within San Diego County.
Ability to work effectively with people of different cultures and socioeconomic backgrounds, demonstrate cultural sensitivity and respect for diversity, and provide service-oriented customer support.
Self-starter who is highly organized, able to prioritize, and able to complete a large volume of work within strict deadlines.
May be required to lift up to 30 pounds, stand and walk frequently indoors and outdoors, and set up and take down event equipment.
Must be able to work some evenings and/or weekends.

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 of applications and required documentation.
Monitor and initiate health coverage redetermination and renewal processes.
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 accurate, complete, up-to-date, courteous, efficient, and timely service to patients, SYH employees, county representatives, outside agencies, and the public.
Conduct follow-up to help families obtain and retain coverage, especially high-acuity patients such as seniors and individuals with disabilities.
Conduct individual and group patient engagement and educational activities at SYH clinic sites and community locations.
Provide information on SYH services and programs, public health assistance, health insurance options, voter registration, and policy issues affecting the community.
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.