Certified Eligibility Specialist
About The Position
Under the supervision of the Patient Service & Eligibility Supervisor, the Certified Eligibility Specialist supports individuals and families in obtaining and maintaining health care coverage. The position provides eligibility education, enrollment navigation, and retention support through patient engagement events and individual assistance at SYH clinic sites and community locations. It also provides information about SYH services and programs, public health assistance, health insurance options, voter registration, and policy issues affecting the community. The role includes completing and following up on health coverage applications and renewals, submitting verification documents, maintaining accurate records, preparing reports and correspondence, and referring patients to SYH and community resources. The specialist provides responsive service to patients, SYH employees, county representatives, outside agencies, and the public; supports on-site training of new staff; and performs other related duties as assigned. The position requires travel within San Diego County and may require evening and weekend work.
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.
- Must pass the Certified Enrollment Counselor (CEC) exam and the SYH Eligibility competency exam within a 90-day probationary period.
- Bilingual English/Spanish skills are required.
- Excellent oral and written communication skills.
- 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.
- 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, prioritize and complete a large volume of work under strict deadlines, and provide prompt and 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 accurate 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 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 activity records, prepare statistical reports and patient/client correspondence, and submit monthly reports by the first of each month.
- Provide courteous, efficient, timely, and accurate service to patients, SYH employees, county representatives, outside agencies, and the public.
- 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 individual and group patient engagement events and educational activities at SYH clinic sites and community locations.
- Provide information about 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.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
