Eligibility and Enrollment Specialist Primary Care Setting

Southwest Care Center•Albuquerque, NM

About The Position

Southwest Care Center employees can answer yes to these 3 questions: 1. Do you want to make a difference? 2. Do you believe everyone is entitled to quality healthcare? 3. Do you desire to serve the underserved in your community? For over 25 years, Southwest Care Center has been providing exceptional healthcare to the communities of Santa Fe and Albuquerque, NM. We are a non-profit, FQHC-LAL providing medical, behavioral health, case management, community outreach, diabetes education, and pharmacy services. We are proud to offer gender equity medicine, syringe exchange, and HIV/HepC treatment, testing and other services within our communities. Southwest Care Center is currently seeking full-time Eligibility and Enrollment Specialist to support our Jefferson Clinic in Albuquerque, NM. Position Details: Under the direction of the Ancillary Services Manager, the Eligibility and Enrollment Specialist is responsible for the patient insurance verification process to ensure proper payment from insurers and to provide assistance that reduces out-of-pocket expenses related to all services performed in a clinical setting, including HIV/HCV services and PrEP/Sexual Health services. The specialist assesses and enrolls patients in assistance programs for which they qualify, interprets and applies the sliding fee scale, and ensures that all related documentation is accurately and consistently recorded in the electronic medical record. Additionally, the specialist enrolls eligible patients into the Ryan White HIV/AIDS Program case management services and assigns them to a case manager. They ensure patients are scheduled for services, track open referrals to support proper follow-through of appointments, and maintain cross-departmental support and collaboration.

Requirements

Minimum high-school diploma and minimum 1 year working in a similar role of enrollment and or referrals.
Valid Driver’s License
Basic Life Support (BLS)
NMDOH HIV/HCV testing certification within 12 months of hire.

Nice To Haves

Prefer bachelors and 3+ years working in enrollment and/or referral role supporting populations as described in this description.

Responsibilities

Assess and enroll eligible patients into Ryan White HIV/AIDS Program case management services at intake.
Determine the patient’s level of Ryan White Sliding Fee Scale and Cap on Charges and educate patients about these benefits.
Assign the patient to the appropriate specialty provider or facility based on the patient’s current medical needs as defined by the primary care provider.
Provide all the required medical history information regarding the patient to the specialty provider or facility.
Coordinate with insurance carriers and specialty practices to obtain prior authorizations, pre certifications and referrals on applicable plans which include HMO, PPO and POS health plans and documents all benefit information into the patients’ electronic medical record.
Attend weekly specialty services meetings as assigned.
Scheduling diagnostic testing for HCV patients if applicable
Scheduling HCV patient medication shipment if applicable
Coordinating HCV patient prior authorization if applicable
Maintain contact with patient to ensure compliance with HCV program requirements.
Schedule necessary provider visits for patients if needed
Assist with HOPWA certifications if applicable
HOPWA reporting if assigned
Weekly, Monthly and Quarterly reporting as assigned
Weekly food pantry inventory/ordering as assigned
Other duties as assigned.

Benefits

Competitive rate of pay.
Great work/life balance with generous time off plans.
Tuition reimbursement availability.
Full benefits package including medical, dental, vision, 401k, paid time off, professional development programs, and 340B prescription access with substantial employer contribution.

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