Eligibility Specialist (Float) - El Pueblo - Case Management

El Rio Community Health Center•Tucson, AZ

8h•$18 - $26

About The Position

The Eligibility Specialist performs administrative processing and determines eligibility for services in support of El Rio Health Center and its operations. The role requires advanced knowledge of community, government, and private social-service agencies and programs, and serves as an informational resource to clients and staff. The specialist supports recruitment, registration, enrollment, and retention for the ACA Marketplace, AHCCCS, and discount programs, and provides referrals to social services and agencies. Work is performed with intermittent supervision and review; issues involving departures from standard policies or procedures are referred to a supervisor or applicable agency representative. The specialist maintains knowledge of governmental and private healthcare programs, including the Affordable Care Act, Healthy Arizona Plus, and the Sliding Fee Scale. The role includes researching program requirements, preparing informational summaries, training and mentoring staff, facilitating refresher and recertification training, and contributing to departmental policies and process improvements. The specialist also performs the duties of an Eligibility Assistant and provides consumer enrollment assistance, eligibility information, reports, data entry, and administrative support. This position requires customer service and communication with consumers, patients, staff, community groups, and agency representatives. It serves as a liaison for eligibility-related problem-solving and training, may deliver presentations on eligibility services, and participates in community events promoting awareness of available healthcare programs. Employees must maintain confidentiality and comply with organizational policies, HIPAA, compliance requirements, and applicable Joint Commission standards. The position requires reliable transportation for possible workday reassignments; a valid driver’s license and Arizona-compliant vehicle insurance are required when driving during work hours.

Requirements

High school diploma or GED.
Three years of experience working as an Eligibility Assistant, Outreach Worker, or Certified Application Counselor for the Affordable Care Act.
Upon employment, obtain and maintain certification and licensing as a Certified Application Counselor for the Affordable Care Act.
Have a current, valid Level I fingerprint clearance card in good standing, or apply for one within seven working days after beginning employment; fingerprint clearance documentation is subject to the stated submission deadlines.
Reliable transportation to accommodate operational reassignments during the workday.
A valid driver’s license and compliance with Arizona vehicle insurance requirements when driving during work hours.
Undergo drug testing before employment and comply with applicable post-accident, reasonable-suspicion, return-to-duty, and follow-up drug and alcohol testing requirements.
Maintain confidentiality and comply with HIPAA and organizational compliance and policy requirements.

Nice To Haves

Bilingual English/Spanish ability, including speaking, reading, and writing in both languages.
Equivalent combinations of education and experience may be considered when directly related to the job’s functions and responsibilities.

Responsibilities

Determine eligibility for services and assist consumers with recruitment, registration, enrollment, and retention in ACA Marketplace, AHCCCS, and discount programs.
Provide information and referrals related to community, government, private healthcare, and social-service programs.
Maintain advanced knowledge of governmental and private healthcare programs, including the Affordable Care Act, Healthy Arizona Plus, and the Sliding Fee Scale.
Research program changes and provide informational summaries and training on healthcare programs.
Train and mentor new and existing staff on regulatory changes and facilitate annual refresher or recertification training.
Participate in reviewing and developing departmental operational policies and procedures and recommend process improvements.
Perform all functions, duties, and responsibilities of an Eligibility Assistant.
Provide timely and accurate scheduled and ad hoc reporting, including eligibility lookups, system-generated reports, and data collection on outreach and operational activity.
Maintain required training and certifications for eligibility and enrollment processing and serve as a Certified Application Counselor for the Affordable Care Act.
Assist consumers with public access to and enrollment in HEAPlus and ACA Marketplace applications using web-based systems.
Generate and distribute program reports, summaries, and correspondence; assist with data entry into program systems, software, and spreadsheets.
Explain eligibility options and requirements and assist consumers with enrollment in Medicaid (AHCCCS) and ACA Marketplace programs.
Respond promptly and effectively to calls, emails, inquiries, support requests, and technical questions or complaints.
Maintain a clean, safe, and hygienic work environment and follow applicable infection-prevention and control procedures.
Comply with confidentiality, HIPAA, corporate compliance, organizational policies, and applicable Joint Commission Certification requirements.
Communicate effectively with employees, clients, patients, visitors, and representatives, and support a respectful and positive work environment.
Serve as a liaison to internal departments and staff for eligibility-related problem-solving and in-service training.
Deliver informational presentations to community groups and individuals on the ACA, AHCCCS, and other eligibility services; prepare presentations and materials that meet CMS guidelines and approval.
Participate in community events that promote health and awareness of healthcare programs and services.
Process operational activity in program systems or spreadsheets to support tracking, reporting, and invoicing of application completion and production.
Maintain proficiency with organizational and agency systems and adapt to system and program changes or upgrades.