Certified Eligibility Specialist

San Ysidro Health; California; On-site; USD 42,000 - 56,000; Full time

Job summary

San Ysidro Health is seeking an Eligibility Specialist to educate patients about eligibility, help enroll in health coverage, and support retention of coverage. You will engage with individuals and families, collect information, determine eligibility, and guide them through the enrollment process.

The role includes handling renewals, referrals to community resources, and preparing monthly reports. Strong bilingual communication, computer literacy, and knowledge of public health programs are

Qualifications

• Excellent oral and written communication skills.
• Bilingual English/Spanish is required.
• Knowledge of local, state and federal public health assistance programs.
• Proficient in Microsoft applications and CalWin/CalHEERS.
• Good computer/tablet literacy including internet navigation.

Responsibilities

• Assists individuals and families in applying for and retaining health coverage by collecting accurate personal and demographic information, determining eligibility, assessing needs, and providing information on health coverage options.
• Uploads and submits verification documents and completed applications.
• Completes and submits health coverage applications, including presumptive eligibility and gateway applications, and ensures timely processing with agencies.
• Monitors and initiates the health coverage redetermination and renewal process.
• Completes Medi-Cal Renewal Packages, CCA Renewal Processes, reports changes on active accounts, and submits Newborn Referrals.
• Facilitates referrals to SYH and community resources to address additional needs and complex issues.
• Maintains accurate records and prepares statistical reports and client correspondence, submitting monthly reports by the 1st.
• Delivers accurate information to patients, SYH staff, county reps, and the public in a courteous, efficient manner.
• Performs follow-up to prevent lapses in coverage, especially for high-acuity patients.
• Conducts patient engagement events and educational activities at clinics and community locations.
• Supports on-site training of new staff under supervision.
• Complies with policies and attends trainings.
• Provides CES coverage as needed.
• Performs other related duties as assigned.

Skills

Bilingual English/Spanish

Excellent oral and written communicati

Customer service mindset

Data entry accuracy

Education

High School Diploma or GED

Bachelor’s degree in health or human services

Tools

Microsoft Office

CalWin

CalHEERS

Job description

Position Summary:

Under the supervision of the Patient Service & Eligibility Supervisor, the Eligibility Specialist provides patient engagement events eligibility education, enrollment navigation, and retention support to assist individuals and families in obtaining and maintaining health care coverage.

Essential Functions of the Job:

• Assists individuals and families in applying for and retaining health coverage by collecting accurate personal and demographic information, determining eligibility, assessing needs, and providing information on health coverage options.
  Uploads and submits verification documents and completed applications.
• Completes and submits health coverage applications, including presumptive eligibility and gateway applications. Initiates and maintains proper follow-up with patient and government agency to ensure timely processing and completion of all mandated applications and accompanying documentation
• Monitors and initiates the health coverage redetermination and renewal process.

• Completes Medi-Cal Renewal Packages, CCA Renewal Processes, reports changes on active accounts, processes Medi-Cal Add-Ons, and submits Newborn Referrals.

• Facilitates referrals to SYH and community resources to address additional needs and complex issues.
• Maintains accurate and thorough records of all activities. Prepare statistical reports and patient/client correspondence. Submits monthly reports by the 1st of each month.
• Provides responsive, high-quality service to patients, SYH employees, county representatives, outside agencies, and the public by delivering accurate, complete, and up-to-date information in a courteous, efficient, and timely manner.
• Conducts follow-up activities to ensure families obtain and retain health coverage, with a particular focus on assisting high-acuity patients (such as seniors or individuals with disabilities) to prevent lapses in coverage.
• Conducts patient engagement events, and educational activities both individually and in groups at SYH clinic sites and community locations. Provides information on SYH services and programs, public health assistance, health insurance options, voter registration, and policy issues impacting the community.
• Supports Patient Service and Eligibility Supervisor with on-site training of new staff, following established procedures and training templates.

Additional Duties and Responsibilities:

• Complies with all departmental, organizational, and government policies and procedures.
• Attends all in-service meetings and trainings.
• Provides CES coverage as needed.
• Performs other related duties as assigned or requested

Job Requirements:

Education Required (Minimum level of education):

High School Diploma or GED equivalent required.

Preferred: Bachelor’s degree in a health or human service field.

Certifications Required:

Must pass the Covered California criminal background check and two exams:

1) Certified Enrollment Counselor (CEC) exam.

2) SYH Eligibility competency exam within a 90-day probationary period.

Reliable Transportation:

This position requires the employee to have the ability to get to and from events.

Experience Required (Minimum level of experience):

A minimum of one year of experience performing eligibility insurance or billing experience.

Related education may substitute for experience.

Verbal and Written Skills Required to perform the Job:

Must have excellent oral and written communication skills.

Bilingual (English/Spanish) is required.

Technical Knowledge and Skills Required to Perform the Job:

Knowledge of local, state and federal public health assistance programs and respective policies and regulations. Proficient in Microsoft applications and use of electronic health data systems including CalWin and Cal HEERS. At a minimum, have good computer/tablet literacy including internet navigation and research skills.

Competencies:

Demonstrates ability to be culturally sensitive and respect diversity, work effectively with individuals of different cultures and socio-economic status; passion for service; self-starter and highly organized; ability to prioritize, and complete a large volume of work within strict time deadlines; provide prompt, efficient and responsive customer service.

Equipment Used:

Computers, laptops, phones, copy machines, fax machines and

other general office equipment.

Working Conditions and Physical Requirements:

• May be required to lift up to 30 lbs., stand and walk frequently indoors/ outdoors; set-up and take down event equipment.

• Will be required to travel to other sites or other locations within San Diego County.
• Will be required to work some evenings and/or weekends.