Patient Eligibility Specialist

First Choice Community Healthcare•Los Lunas, NM

About The Position

Under the close supervision of the Outreach and Enrollment Program Manager or Health Center Manager, as applicable, the eligibility specialist works with patients and the public to determine eligibility for various healthcare funding programs, in a manner that is supportive and responsive.

Requirements

High School graduate or GED certificate
At least two years related experience and/or training is required.
Obtain within first 6 months of hire/maintain a Presumptive Eligibility Determiner Number.
Comfort working with people one on one and in giving group presentations
Proficiency using the Internet and various software programs and computers
Proficiency using a laptop, wireless card, mobile scanners and cell phones
Good interpersonal communication skills and ability to establish a sense of trust while also maintaining professional relationship
Basic knowledge of health insurance and the health delivery systems
Ability to recognize and address barriers including cultural and language differences
Ability to summarize and explain complex information in different ways to meet different learning styles and needs of clients
Ability to work independently, and as part of a team, in the field and in office settings
Ability to manage time and priorities effectively and to meet deadlines
Ability to work on multiple tasks and to be flexible with schedule and assignments
Ability to work under the direction of a supervisor and follow detailed instructions
Ability to take the initiative to resolve patient concerns and problems
Ability to travel outside the county on a daily basis if needed
Knowledge and familiar with compliance program, corporate fully and comply with laws and regulations.

Nice To Haves

Bi-lingual English/Spanish is preferred.

Responsibilities

Provide accurate and impartial information to patients and the general public about health insurance coverage available to them and their families under the Affordable Care Act.
Conduct outreach and education activities in clinics and in community settings and door-to-door (as appropriate) on weekdays, weekends and evenings, as scheduled, to meet community needs.
Explain and assist existing patients and the general public with eligibility determination and application for various healthcare financial assistance and/or insurance programs, including all forms of Medicaid, Medicare, UNM Care, NM Health Insurance Exchange plans; Title X, BCC, CRC, Title V, and sliding fee discounts.
Verify insurance eligibility for Medicaid, Medicare, and third party payors, ensuring that all documentation has been accepted by HSD or other agencies.
Update patient records in the practice management system including income and insurance information.
Provide information to patients and the general public concerning functions of FCCH, ensuring customer satisfaction and the highest level of customer service.
Ensure that monthly quotas for enrollment are met and documented for grant reporting.
Answer the telephone and connect callers to the appropriate offices or individual staff, as necessary.
Refer callers to other agencies when FCCH cannot meet needs.
Schedule appointments over the telephone and in person using the practice management system and other software as needed.
Other Duties, As Assigned.