Eligibility Specialist - Ambulatory Finance

Valleywise Health System•Phoenix, AZ

About The Position

Under the direction of the Director of Patient Access, the Eligibility Specialist ensures that patients receiving services from Valleywise Health have been properly screened for self-pay financial assistance. The role gathers thorough documentation and enters information into various systems while monitoring and following all compliance policies. It ensures accurate and timely processing of accounts and registers patients. The position obtains necessary verification of insurance and other eligibility programs, initiates and assists patients in completing AHCCCS applications, and tracks and monitors their completion. It performs quality checks on eligibility and AHCCCS applications initiated in the department and ensures they are processed for every self-pay or unverifiable payer source. The role also performs quality assurance checks on the AHCCCS application program and works with management and other staff to identify and resolve issues that threaten billing and reimbursement.

Requirements

High school diploma or GED.
At least two years of progressively responsible interviewing or investigative experience obtaining confidential information.
Direct experience with the AHCCCS application process demonstrating understanding of the required knowledge, skills, and abilities.
Valid fingerprint clearance card issued by the Arizona Department of Public Safety, or submission of a completed affidavit at hire; complete the fingerprint clearance card application within seven days of hire and present the actual card within 90 days of applying.
Excellent data-entry skills, including 10-key by touch, and accurate typing at 30 words per minute.
Basic math skills.
Ability to demonstrate interviewing and investigative techniques to obtain information that may not be offered.
Good verbal and written interpersonal and communication skills, including basic grammar, spelling, and punctuation.
Ability to read, write, and speak effectively in English.
Ability to handle multiple tasks simultaneously.

Nice To Haves

Insurance verification experience.
Medicaid eligibility experience.
Critical thinking skills.

Responsibilities

Screen patients for self-pay financial assistance.
Gather thorough documentation and enter information into various systems.
Monitor and follow compliance policies.
Ensure accurate and timely processing of accounts and register patients.
Obtain necessary verification of insurance and other eligibility programs.
Initiate and assist patients in completing AHCCCS applications.
Track and monitor AHCCCS application completion.
Perform quality checks on eligibility and AHCCCS applications initiated in the department and ensure processing for every self-pay or unverifiable payer source.
Perform quality assurance checks on the AHCCCS application program.
Work with management and other staff to identify and resolve issues that threaten billing and reimbursement.