Eligibility Specialist - Flagstaff 4th St. (Elk Ridge) - OB/GYN

ViziRecruiter,LLC.; Flagstaff (AZ); On-site; USD 40,000 - 50,000; Full time

Job summary

ViziRecruiter, LLC. is looking for an Eligibility Specialist based in Flagstaff, Arizona. The successful candidate will perform administrative duties related to the determination of eligibility for various health services and provide essential application assistance to clients.

The role entails creating presentations, engaging in public speaking, and maintaining compliance with healthcare guidelines. This position supports Elk Ridge Community Health's mission of delivering accessible healthcare to all.

Qualifications

• 3 years’ experience as an Eligibility Assistant or related role.
• Ability to maintain confidentiality and compliance with HIPAA.
• Effective communication skills with various stakeholders.

Responsibilities

• Determine eligibility for services and provide application assistance.
• Facilitate presentations on eligibility services.
• Conduct public speaking engagements to educate the community.

Skills

Customer service skills

Bilingual (English/Spanish)

Public speaking

Education

High school diploma or G.E.D.

Tools

MS Office (Word, Excel, PowerPoint, Outlook)

Job description

Introduction

Love where you work as much as you love where you live by joining Elk Ridge Community Health.

Overview

The Eligibility Specialist (Elk Ridge) is responsible for performing administrative duties and processing which include the determination of eligibility for services and application assistance in support of Elk Ridge Community Health services and its varied operations. The incumbent in this position will possess and demonstrate an advanced and comprehensive understanding of community, government, and private social services/agencies and programs; serves as an informational resource to clients and staff members. This includes eligibility requirements and procedures to effectively support the recruitment, registration, enrollment, and retention of consumers to the ACA Marketplace, AHCCCS, or discount programs; as well as referrals to social services or agencies.

An Eligibility Specialist (Elk Ridge) works with intermittent supervision and review, and any work problems involving departures from standard policies, interpretations, or procedures are reviewed with the supervisor, or applicable agency representative for resolution.

The primary goal of the Elk Ridge Community Health Eligibility Specialist (Elk Ridge) is to support Elk Ridge’s Mission of providing comprehensive, quality health care that is affordable and accessible to all who may have healthcare needs, by successfully performing the primary essential functions.

The following functions and responsibilities will contribute to Elk Ridge Community Health to achieve its KEY RESULTS:

1. World Class Experience for staff and patients
2. Healthier patients and employees
3. Positive Financial Result

• Serve as a contact point and liaison to internal departments and staff for problem-solving and in-service training related to eligibility services.
• Facilitate internal and external informational presentations to community groups or individuals on Affordable Care Act, AHCCCS, and other eligibility services.
• Perform public speaking on eligibility services to large and small groups in informal or formal settings.
• Create presentations and materials that will meet the Center for Medicare/Medicaid Services (CMS) guidelines and approval.
• Support El Rio Health by participating in community events that promote good health and which contribute to a broader awareness and understanding of the governmental and private healthcare programs or services available to the community.
• Complete administrative processing of operational activity into program systems or spreadsheets to support effective and timely tracking, reporting, and invoicing of application completion and production.
• Gain and maintain proficient skill with all organizational or agency operating systems and programs by adapting to changing requirements and successfully learning and demonstrating new skills in response to system and program improvements or upgrades.

Joint Commission Responsibilities:

• Maintain a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control, etc. for this position.
• Demonstrate an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.

Responsibilities

• Perform all assigned tasks, responsibilities, and assignments supporting departmental operations within established periods; meeting established rates of performance for the quality and quantity of work for the position; and demonstrating the highest levels of professionalism, quality, efficiency, and accuracy in the employee’s job performance that exhibits the highest standards of excellence.
• Understand and comply with all organizational Code of Conduct standards, Policies and Procedures, and Service Excellence requirements with all consumers, patients, visitors, employees, and internal/external clients or representatives.
• Maintain at all times employee and/or patient confidentiality by controlling the environment and information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as accepted human resources confidentiality standards.
• Gain and maintain a comprehensive and advanced knowledge, skills, and expertise on governmental and private healthcare programs, such as Affordable Care Act, Healthy Arizona Plus, Sliding Fee Scale, etc.
• Perform ongoing investigative research in order to provide informational summaries and training on governmental and private healthcare programs.
• Serve as trainer and mentor to new and existing staff members on regulatory changes.
• Facilitate annual refresher or recertification training on the Affordable Care Act and other governmental or private healthcare programs.
• Participate in the review and development process of department operational policies and procedures.
• Provide recommendations on operational functions and process improvement or enhancement.
• Fulfill and perform all of the functions, duties, and responsibilities of an Eligibility Assistant.
• Provide timely and accurate scheduled or ad hoc reporting to internal/external departments or representatives, such as client eligibility status lookup, system generated reports, and data collection on outreach and operational activity.
• Gain and maintain the knowledge, understanding, and skills to complete assigned administrative and clerical duties, tasks, and assignments working with program operating systems, programs, and/or business software.
• Obtain and maintain all training requirements and certifications necessary for eligibility and enrollment processing, and to serve as a Certified Application Counselor for the Affordable Care Act.
• Support and assist consumers with public access and enrollment to HEAPlus and ACA Marketplace applications utilizing web-based systems and software.
• Generate and distribute reports, summary information, and correspondence for the program for internal/external clients or representatives; as well as assist with data entry of information and content into program systems, software, or spreadsheets for effective operational use and reporting.
• Support and assist consumers by providing explanations, enrollment assistance, and information on eligibility options and requirements for programs such as Medicaid (AHCCCS), ACA Marketplace.
• Demonstrate an exceptional level of customer service; answering and responding to all incoming calls, emails, and inquiries in a timely and effective manner; responding to requests for support providing information and solutions in response to inquiries; resolving technical inquiries or complaints.
• Communicate effectively through written, verbal, and interpersonal skills as applied when interacting with employees, internal/external clients or representatives, patients, or visitors, successfully conveying and exchanging information in a positive manner.
• As a team player, demonstrate self-initiative by being aware of the work environment in order to assist co-workers and others while maintaining and enhancing a respectful and positive attitude in the work environment. Serve at all times as a positive and effective employee.
• Participate in a learning environment by being willing to teach other employees, providing new skills and knowledge that will enhance and improve the quality of service provided to consumers, as well as all internal/external clients or representatives.

Requirements

• High school diploma or general education diploma (G.E.D.).
• 3 years’ experience working as an Eligibility Assistant, Outreach Worker, or Certified Application Counselor for the Affordable Care Act.
• Upon employment, gain and maintain certification and licensing as a Certified Application Counselor for the Affordable Care Act.
• Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment.

Applicable equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Preferred Qualifications

• Bilingual (English/Spanish) with the ability to speak, read, and write in both languages.

Transportation

• Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

Core Competencies

• Organization
• Time Management
• Teamwork
• Compassionate Communication
• Cultural Competence
• Honor Patient Privacy
• Service Recovery

Skills and Abilities

• Effective customer‑facing and presentation skills.
• Interact diplomatically and positively with patients and the public in a continuous public contact setting.
• Ability to respond effectively in writing and verbally to internal and external customers.
• Write grammatically correct routing business correspondence such as brief transmittal memoranda.
• Proficient with MS Office, including Word, Excel, PowerPoint, Outlook, and the internet.
• Apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to multi‑task and maintain a professional composure in stressful situations.
• Excellent organizational and time‑management skills.
• Interact with persons of various social, cultural, economic and educational backgrounds for the purpose of providing exceptional guidance and customer service.