Eligibility Coordinator

LA FAMILIA•Hayward, CA

5d•$31 - $36•Hybrid

About The Position

As part of La Familia’s Community Health Center front office team, this role prepares and submits required eligibility screening and information for all patient visits at the health center. The Eligibility Coordinator is responsible for providing enrollment, assistance, information, and support to new and established patients in determining eligibility for health services under various private and public health care assistance programs. This position also serves as a patient registrar and navigator for new patients to their health center and provides screening and enrollment at community outreach events. This position reports to the Clinic Director/Administrator and works closely with the Finance Dept., external CRM vendors, and health center staff. The role upholds and champions the agency’s mission, vision, and values and contributes to a collaborative and inclusive work culture.

Requirements

High school diploma or GED required.
Minimum 3 years of experience in patient registration, insurance verification, eligibility determination, or enrollment experience strongly preferred
Two years’ experience in a community health care environment, FQHC, public health or primary health care setting preferred.
2-3 years of experience in Medi-Cal eligibility, Covered California enrollment, and other public/private insurance programs strongly preferred.
Bilingual (English/Spanish or other language relevant to community) strongly preferred.
Experience working in an FQHC, community clinic, or safety-net environment is highly desirable.
Strong understanding of healthcare eligibility requirements, including Medi-Cal, Medicare, commercial plans, and sliding fee scales.
Knowledge of HRSA health center program requirements for patient eligibility and sliding fee discount programs.
Proficiency in Electronic Health Records (EHR) and eligibility verification systems.
Excellent customer service and communication skills, especially with underserved and diverse populations.
Demonstrates and models excellent “customer service” orientation and ability to work with diverse populations.
Exercises extreme discretion with the ability to hold, balance, and transmit public and confidential information needed by various parties.
Proficient in MS Office and Google Workspace products.
Valid CA Driver’s license required.
Auto insurance: If your vehicle is used for business-related purposes, it is recommended that you inform your auto insurance carrier.
Demonstrates cultural awareness and provides respectful, client-centered care.
Maintains knowledge of community resources for client referrals
Attend work regularly, adhering to policies on absences and tardiness.
Understands and applies legal requirements, including confidentiality and risk management.
Viewed by others as an effective team member who is flexible, cooperative, and willing to assist others, and acts as a resource to team members and clients, where appropriate.
Handles difficult or conflict situations constructively and seeks appropriate assistance.
Accepts accountability and constructive feedback.
Attends all mandatory meetings and staff meetings as required, and actively participates in other departmental professional development, including providing training and consultation.
Develops and maintains cooperative and courteous relationships with fellow employees, supervisors, managers in other departments, senior management, executive staff, and community stakeholders.
Handles requests, suggestions, and complaints from other departments and individuals in a tactful and effective manner to maintain goodwill within the agency.
Ability to safely operate a motor vehicle
Ability to push, pull, and lift up to 50 pounds frequently.
Ability to stand and move from one location to another daily.
Ability to sit for prolonged periods of time
Ability to visually focus on near and far items, and to be able to switch between them.
Ability to reliably report to work on time and perform the position's required tasks as scheduled
Ability to grasp and carry items
Ability to hear and effectively communicate with co-workers, clients, and the public
Ability to identify potential issues within the workplace, determine an appropriate means of avoiding and/or resolving the issues, work with others to address the issues, and carry out organized strategies for resolving and preventing similar issues in the future
Ability to process information and data for use within the organization

Nice To Haves

Associate Degree preferred.
Bilingual (English/Spanish or other language relevant to community) strongly preferred.
Experience working in an FQHC, community clinic, or safety-net environment is highly desirable.

Responsibilities

Responsible for preparing all eligibility information for each scheduled clinic patient at least two days ahead of the appointed time.
Works collaboratively with front desk staff to ensure that all scheduled and non-scheduled patients are checked for eligibility and that all information is entered accurately and thoroughly.
Interviews and screens new and established patients to determine eligibility for health insurances and other programs.
Serves as an initial point of contact for patients looking to enroll in primary care services.
Enters and documents pertinent patient messages, eligibility information, and alerts in the patient's chart or electronic health records as needed to ensure accurate communication and coordination between the front office and billing department regarding patient eligibility status.
Assists patients and community members with completing and submitting applications for county and state benefit programs.
Registers new patients, schedules appointments and provides information on La Familia Community Health Center locations, services and available programs.
As part of the health center front office team, assists with front office operations at the health center as needed.
Responsible for tracking and reporting all required data for enrollment and outreach efforts to support program goals, compliance requirements, and performance monitoring.
Conducts timely follow-up with prospective patients through phone, email, and in-person contact to guide and support their enrollment process from initial inquiry to intake completion.
Maintains accurate statistical records, reports, and tracking systems to monitor enrollment activities, outreach efforts, and program outcomes.
Attends all meetings that apply to the eligibility process and shares the information with appropriate clinic personnel. These meetings are typically off-site and will require the use of personal vehicle or other transit.
Takes all classes and tests to become a Certified Enrollment Counselor.
Adhere to federal and state regulations governing eligibility determination.
Attend eligibility-related meetings; assist with referrals to Medi-Cal and CalFresh.
Maintain detailed records for County, State and HRSA and funding compliance.
Participate in eligibility department audits and trainings.
Participate in community outreach events to promote enrollment services.
Provide interpretation and navigation support for LEP patients.
Attend trainings and participate in events relevant to key responsibilities.
Track and regularly report on key metrics for the responsible function areas.
Leads and collaborates on projects supporting Agency objectives.
Performs other duties and projects as assigned.
Accurately record work hours each day by clocking in/out at scheduled start, break, lunch, and end times.
Take all required meal and rest breaks in compliance with state, federal, and agency policies.
Review and submit timesheets by established deadlines to ensure timely payroll processing.
Notify supervisor promptly of any scheduling conflicts, absences, tardiness, or timekeeping issues.
Maintain consistent and reliable attendance to support team and program operations.
Follow organizational policies and procedures related to overtime, schedule changes, and paid/unpaid leave.
Correct and/or report any timekeeping discrepancies immediately to the supervisor for resolution.

Benefits

Medical, dental, and vision benefits with 95% employee and 80% dependent employer premium contributions
Employer-paid life insurance
Vacation
15 paid holidays
12 paid sick days upon accrual
Employee Assistance Plan
Pet Plan Benefit: PetPlus Product and Prescription Discounts, Pet Assure Veterinary Discounts, AskVet 24/7 Pet Telehealth, and ThePetTag Lost Pet Recovery Service
403(b) retirement plan
Flexible scheduling options, including hybrid work arrangements
License and Certification renewals reimbursed
Opportunities for Growth and Professional Development
Structured mentorship
Ongoing training