Certified Eligibility Specialist

San Ysidro Health•Chula Vista, CA

6d•$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 to help individuals and families obtain and maintain health care coverage. The role assists with applications, eligibility and renewal processes, follow-up, referrals, recordkeeping, reporting, and patient education at clinic sites and community locations. It also supports training of new staff and provides coverage as needed.

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.
Pass the Certified Enrollment Counselor (CEC) exam and the SYH Eligibility competency exam within a 90-day probationary period.
Reliable transportation and ability to travel to events.
Excellent oral and written communication skills.
Bilingual English/Spanish proficiency.
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 work sensitively and effectively with people from different cultures and socioeconomic backgrounds; service orientation; self-direction and organization; ability to prioritize and complete a high volume of work under strict deadlines; and prompt, efficient, responsive customer service.

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, and follow up with patients and government agencies to ensure timely processing and completion of required applications and 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 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.
Conduct follow-up to help families obtain and retain coverage, especially high-acuity patients such as seniors and individuals with disabilities, to prevent coverage lapses.
Conduct patient engagement events and individual and group 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.