Certified Eligibility Specialist

San Ysidro Health•El Cajon, CA

About The Position

Under the supervision of the Patient Service & Eligibility Supervisor, the Certified Eligibility Specialist provides patient engagement, eligibility education, enrollment navigation, and retention support to help individuals and families obtain and maintain health care coverage. The role serves patients and families at SYH clinic sites and community locations and supports people with complex needs, including seniors and individuals with disabilities, to help prevent lapses in coverage. The position also provides information about SYH services and programs, public health assistance, health insurance options, voter registration, and policy issues affecting the community. It supports the supervisor with on-site training of new staff and performs other assigned duties. The role requires travel to events and other locations within San Diego County, and some 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.
Bilingual English/Spanish communication 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 obtain reliable transportation to and from events.
Must 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.
Ability to demonstrate cultural sensitivity and respect for diversity, and work effectively with people of different cultures and socioeconomic statuses.
Service-oriented, self-starting, and highly organized, with the ability to prioritize and complete a large volume of work under strict deadlines and 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.
Ability to travel to other sites and locations within San Diego County and work some evenings and/or weekends.

Nice To Haves

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

Responsibilities

Collect accurate personal and demographic information, determine eligibility, assess needs, and explain health coverage options to individuals and families.
Assist individuals and families with applying for and retaining health coverage.
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 ensure timely processing and completion of applications and supporting 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 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, and up-to-date information and courteous, efficient, 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 events 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 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; and provide CES coverage as needed.
Travel to events and other sites or locations within San Diego County.
Perform other related duties as assigned or requested.