Patient Eligibility Specialist

First Choice Community Healthcare INC•South Valley, 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 and insurance programs in a supportive, responsive manner. Work is performed primarily in health centers and office settings, with outreach in clinics and community settings and 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 a Presumptive Eligibility Determiner Number within the first six months of hire and maintain it.
Comfort working with people one-on-one and giving group presentations.
Proficiency using the Internet, computers, and various software programs.
Proficiency using a laptop, wireless card, mobile scanners, and cell phones.
Good interpersonal communication skills and ability to establish trust while maintaining a professional relationship.
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’ different 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 effectively and meet deadlines.
Ability to handle multiple tasks and be flexible with schedule and assignments.
Ability to work under a supervisor’s direction and follow detailed instructions.
Ability to take initiative to resolve 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.

Nice To Haves

Bilingual English/Spanish.

Responsibilities

Provide accurate, impartial information about health insurance coverage available under the Affordable Care Act to patients and the public.
Conduct outreach and education in clinics, community settings, and door-to-door when appropriate, including on weekdays, weekends, and evenings as scheduled.
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 documentation has been accepted by HSD or other agencies.
Update patient records in the practice management system with income and insurance information.
Provide information about FCCH functions and support customer satisfaction and a high level of customer service.
Meet and document monthly enrollment quotas for grant reporting.
Answer telephone calls and connect callers to 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.