Eligibility Specialist

One Community Health; Sacramento (CA); On-site; USD 52,000 - 68,000; Full time

Job summary

One Community Health in Midtown – Sacramento, CA is seeking an Eligibility Specialist to assist families and individuals without health coverage with enrollment support for health insurance and related programs.

The role focuses on enrollment, renewals, and re-enrollments for Covered California and Medi-Cal while coordinating with care teams to ensure accurate data entry, compassionate patient service, and smooth access to benefits. This position emphasizes teamwork and patient-centered care.

Qualifications

• High School Diploma or equivalent required.
• Minimum 3 years of customer service experience.
• Covered California Certification required or obtained after training.
• CPE certification required or obtained after training.
• Valid BLS/CPR certification required.

Responsibilities

• Assist patients with enrollment into Covered CA and Medi-Cal.
• Provide information and guidance on Covered California programs.
• Coordinate intake forms and data entry into the EHR within 24 hours.
• Support onboarding and cross-training within departments.
• Communicate empathetically in person and by phone.

Skills

Customer service

Education

High School Diploma or equivalent

Tools

Epic (EHR)

Job description

Eligibility Specialist
The purpose of this position is to assist families and individuals without health coverage by providing enrollment support for health insurance and related programs, including initial application, annual renewals, and periodic re-enrollments.

Location:
This role is located in Midtown – Sacramento, CA (95811).

Essential Functions

Customer Service

• Demonstrates empathy, patience, and cultural sensitivity when assisting patients, particularly those experiencing hardship, language barriers, or lack of insurance.
• Performs job duties and makes decisions that are in the best interests of our patients and One Community Health.
• Actively listens to patients and client questions or concerns and responds with professionalism, both in person and over the phone.
• Promptly and courteously provides information and services.
• Take initiative to seek assistance to ensure patient requests are addressed in a manner, which minimizes inconveniences to all parties.
• Collaborative engagement and support in training and onboarding initiatives for transition of new employees and/or conducting departmental cross training across the organization.

Client/Patient Liaison

• Provides client/patient support by conducting concise, courteous and informed professional interviews for New Patient Registrations and re-certifications.
• Provides assistance to secure complete and accurate enrollment into Covered CA, Medi-Cal, Medi-Cal programs such as Sliding Fee Scale discount programs, referral-based programs, Children Presumptive Eligibility program (CPE), Presumptive Eligibility for Pregnant Women (PE4PW), and Newborn Medi-Cal gateway, Qualified Medicare Beneficiary (QMB), Medicare, and Health Care Options.
• Obtain annual state certification for Covered California Enrollment and Medi-Cal benefit programs.
• This Position works as one of many Covered California Sites and one of three PrEP-AP Enrollment Worker sites in Sacramento County.
• Assist patients in navigating and understanding their choices within California’s official health insurance marketplace, also known as Covered California.
• Provides education to patient/client on responsibilities with insurance coverage, co-pays, deductibles, out-of-packet cost, share-of-cost, and co-insurance.
• Assist with completion of the Sliding Fee Discount Application by collecting required valid documentation and educates about annual income caps.
• Works closely with Physicians, Pharmacy, Case Managers, and outside agencies to ensure positive outcome for eligibility determination when immediate resolution is not forthcoming.

Data Management

• Coordinates with other department’s staff in obtaining intake forms and documentation to ensure information is complete and accurate. Data must also be entered within 24 hours into the Electronic Health Record system.
• Ensure that all documentation is signed and scanned into the electronic health record system or promptly forwarded to the HIM department for scanning.
• Document all communication with patients within the EMR using department smart phases as needed to ensure all required data is obtained.

MINIMUM REQUIREMENTS

• High School Diploma or equivalent required.
• Three years of previous experience in customer service.
• Covered California Certification
• Required to obtain after training.
• CPE certification
• Required to obtain after training.
• Valid BLS/CPR certification

PREFERRED BACKGROUND

• Experience with Epic (EHR)
• AA Degree.
• Ability to collaborate effectively across a broad spectrum of backgrounds and perspectives. Candidates who demonstrate inclusive thinking and interpersonal awareness help strengthen our commitment to equitable and compassionate care for all.
• Demonstrated person-centered approach and familiarity with trauma informed systems and restorative practices

Reasonable Accommodations

One Community Health endorses and supports the Americans with Disabilities Act of 1990 (ADA) and the California Fair Employment and Housing Act (FEHA) and is committed to providing reasonable accommodations to qualified individuals with disabilities who are applicants or employees who need accommodations. If you require an accommodation due to a disability to complete this application or you are experiencing difficulty submitting your application, please contact us at [e-mail].

Our Benefits

For more information on the comprehensive benefits we provide, please visit: https://onecommunityhealth.com/careers/recruitment

Additional Information

We only employ US citizens and non-US citizens authorized to work in the United States in compliance with federal law.