Eligibility and Enrollment Specialist - 7D - Spanish Req.

NATIVE AMERICAN HEALTH CENTER INC • Oakland, CA

1d • $28 - $33

About The Position

The Eligibility Specialist (ES) will work as a part of a multi-disciplinary team of individuals who provide high quality patient care. The ES will work in and advanced capacity to identify appropriate funding sources (e.g., Medi-Cal, CHDP, private insurance, sliding scale, and other contracted programs) that may cover the cost of treatments. The ES will directly enroll patients through the County/State databases and will conduct outreach to retain coverage, re-determine eligibility, and re-enrollment of programs and insurances for individuals and families. The ES will explain program and insurance benefits information to patients and assists patients with accessing services at the Native American Health Center. As the ES deals directly with the public, superior customer service skills, effective communication and advanced knowledge of eligibility and enrollment of multiple insurance programs available to underserved populations is required. The Native American Health Center is an accredited institution and adheres to the standards of excellence set forth by the Accreditation Association of Ambulatory Health Care (AAAHC) and the Commission of Dental Accreditation (CODA).

Requirements

• High school diploma or GED and four years of experience in a community health setting or two years of college course work in a related field and two years’ related work experience; or equivalent combination of education and experience.
• Required CAA/CEC certified or must be able to complete certification within 90 days of hire.
• Experience using both an electronic health/dental record system and Practice Management system such as Dentrix, Healthpro, or Nextgen. Must also be proficient at Microsoft Office Suite
• Must be able to provide TB and Physical clearance prior to start date.
• Able to furnish Vaccination history prior to start date dependent on role.
• BLS/CPR certification must be obtained prior to start date and kept current at all times.
• Must be able to type at least 30 WPM.
• Knowledge of private insurance eligibility and benefits
• Familiarity with various state and county funding sources is desirable. CMSP/ACE; Medicare; Medi-Cal; Healthy Families; SOFP; Presumptive Eligibility; AAH Family Care; and other payment sources.
• Knowledge of One E Application is a plus.
• Ability to learn and understand NAHC billing procedures and flows.
• Knowledge of the Bay Area Native community and have a commitment to serving Native Americans and vulnerable patient populations.
• Fluency in both English and Spanish, written and verbal. English fluency is required in order to communicate essential health-related information to both patients and staff is required.
• Professionalism at all times, and the ability to conduct oneself in a respectful manner; be a team player, and have superior communication skills – verbal and in writing.
• Must be able to work well in extremely fast-paced environments and in high-volume situations.
• Have the ability to work independently with minimal supervision and exercise sound judgment and make decisions appropriate to scope of authority and practice.
• Must be available to work some weekends as needed for business necessity.

Nice To Haves

• Healthy Families certification preferred- CAA certification (course completion, within the first two weeks of employment)
• Certified Enrollment Counselor (CEC), Covered CA (course completion, within the first 90 days of employment, finger printing and state background check required)
• HIPAA Training Certificate

Responsibilities

• Greet all patients in a courteous and professional manner to create and maintain a welcoming atmosphere.
• Provide patient customer service by; scheduling patient appointments appropriately, answering and retuning telephone calls in a timely manner, informing patients of process and procedures to accessing services.
• Proactively manage and “tetris” appointment scheduling to maximize productivity and to fill appointment gaps.
• Conduct patient financial screenings to determine their eligibility for County Medical Services Program (LIHP/ACE); Medicare; Medi-Cal; Healthy Families; State Office of Family Planning (SOFP); Presumptive Eligibility; Alameda Alliance for Health-AAH Family Care; and other payment sources
• Use OneEapp/CalHeers/Covered CA Portals as a means to determine eligibility and enroll into eligible programs
• Provide Covered CA education on available plans/metal tiers clients are eligible to enroll in.
• Follow all enrollment criteria, eligibility rules/requirements, and maintain certification of any and all Federal, State, County health programs NAHC is required to follow.
• Assist patients with completing forms and applications for various payment programs.
• Register members into NAHC member portal. Provide user support and education on portal functionality.
• Manage NAHC member portal appointment request and member messages.
• Assist patients with completing their Medi-Cal applications; and follow-up with the county’s Medi-Cal worker to ensure approval of applications, during the Medi-cal workers scheduled on site visits.
• Answer inquiries and provide counseling to patients regarding Medi-Cal and Medicare and their managed care systems in a clear and professional manner that ensures their understanding.
• Responsible for entering accurate assigned payer codes in (PMS), entering expiration dates according to guidelines, terminating inactive payer codes, and select appropriate payers codes for services.
• Register patients into the practice management system (PMS) in a manner that ensures accuracy and thoroughness and update patient registration information once per year at minimum, or as information changes. Inform patients of Notice of Privacy Practices and obtain the patients signed acknowledgement statement with at least 90% data accuracy.
• Update patients’ financial information in the practice management system (PMS) in a manner that ensures completeness, accuracy and timeliness; and follow up on patients’ ‘pending statuses’ for payment programs.
• Proactively provide input in developing and maintaining eligibility criteria and procedures consistent with NAHC’s goals and objectives.
• Generate Practice Management reports as needed for the operations and functions of the Member Services Department.
• Maintain patient insurance data base rolls by proactively tracking expiration dates, Primary Care assignments, and pending statuses.
• Conduct direct outreach to patients due for re-newel applications of insurance programs to maintain retention of coverage.
• Meet regularly with the Director, Member Services to discuss patient eligibility problems and/or other issues that are, or may, affect Member Services or the ability to provide high quality care.
• Provide back-up for Patient Services Coordinators, possibly during Evening and Saturday clinics, as requested by direct supervisor. Follow all NAHC registration, check-in, and payment procedures of the Member Services Department.
• Assist the Billing department in resolving billing problems, as requested by direct Supervisor.
• Assist Director, Member Services with staff trainings of States programs, eligibility, benefits, and enrollment processes.
• Participate in Saturday clinics and after-hour clinics, on a rotating basis, as assigned by Supervisor.
• Attend staff and departmental meetings, as well as special training sessions related to new eligibility criteria for payer programs – when requested by direct supervisor.
• Participate in special NAHC internal committees and task forces, as appropriate – including in internal Continuous Quality Improvement efforts and on internal Continuous Quality Improvement teams.
• Participate in community outreach activities, agency advocacy, and serve on ad hoc committees, as requested by direct supervisor.
• Assist with language translation as needed for healthcare services.
• Follow clinic policies and procedures, including maintenance of client confidentiality under HIPAA privacy rules to ensure that the principles of NAHC
• Member Care: Demonstrate understanding and apply working knowledge of safety policies and ensuring safe member practices.
• Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well the safety of others.
• Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
• Quality Improvement: Actively participate in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards, when assigned.
• HIPAA: Keep all protected health information (PHI) confidential and abide by HIPAA policies for the release and disclosure of any PHI. Will report unauthorized use of disclosure of PHI immediately, to supervisor or HIPAA security officer.
• Work well under pressure, meet multiple and often competing deadlines.
• At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.
• Other duties as assigned by Supervisor.

Benefits

• Native American Health Center (NAHC) considers our employees to be our most valuable resource and offers an excellent benefit package: competitive salaries, personal time off (PTO) or sick/vacation leave program, and an employer contribution 403(b) retirement plan to full-time regular status employees. We also provide medical, vision, dental, flexible spending, group term and voluntary life insurance coverage for employees and their dependents—with a percentage of employee contribution for dependent medical premiums.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED