Patient Eligibility Specialist

First Choice Community Healthcare•Albuquerque, NM

About The Position

The Patient Eligibility Specialist works under the close supervision of the Outreach and Enrollment Program Manager or Health Center Manager, as applicable. The role supports patients and the public in determining eligibility for healthcare funding programs in a supportive and responsive manner. The specialist provides outreach, education, application assistance, eligibility verification, patient-record updates, scheduling, and customer service. Work takes place in health centers, community settings, and field locations, with travel throughout the Greater Albuquerque metropolitan area. The schedule includes some weekends and evenings.

Requirements

High school graduate or GED certificate.
At least two years of related experience and/or training.
Obtain and maintain a Presumptive Eligibility Determiner Number within the first six months of hire.
Comfort working one-on-one with people and giving group presentations.
Proficiency using the Internet, software programs, computers, laptops, wireless cards, mobile scanners, and cell phones.
Good interpersonal communication skills and the ability to establish trust while maintaining professional relationships.
Basic knowledge of health insurance and healthcare 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 clients' learning styles and needs.
Ability to work independently and as part of a team in field and office settings.
Ability to manage time and priorities, meet deadlines, handle multiple tasks, and remain flexible with schedules and assignments.
Ability to work under a supervisor's direction and follow detailed instructions.
Ability to take initiative in resolving patient concerns and problems.
Ability to travel outside the county daily if needed.
Knowledge of the compliance program and ability to comply with applicable laws and regulations.
Ability to prioritize and respond to diverse job demands.
Good dexterity to operate a personal computer and office equipment; occasional lifting and carrying related to office duties.
Ability to read computer monitors and outputs accurately and communicate clearly and accurately for work and safety compliance.

Nice To Haves

Bilingual English/Spanish.

Responsibilities

Provide accurate, impartial information to patients and the public about health insurance coverage available under the Affordable Care Act.
Conduct outreach and education in clinics, community settings, and door-to-door when appropriate, including scheduled weekdays, weekends, and evenings.
Explain and assist with eligibility determination and applications for healthcare financial assistance and insurance programs, including Medicaid, Medicare, UNM Care, New Mexico Health Insurance Exchange plans, Title X, BCC, CRC, Title V, and sliding fee discounts.
Verify eligibility for Medicaid, Medicare, and third-party payors, ensuring required documentation has been accepted by HSD or other agencies.
Update patient records in the practice management system, including income and insurance information.
Explain FCCH functions and provide a high level of customer service to support patient satisfaction.
Meet and document monthly enrollment quotas for grant reporting.
Answer telephone calls and connect callers with appropriate offices or staff.
Refer callers to other agencies when FCCH cannot meet their needs.
Schedule appointments by telephone and in person using the practice management system and other software as needed.
Perform other duties as assigned.