Patient Benefits & Eligibility Specialist

Avenir Senior Living; Surprise (AZ); Sur place; USD 25 000 - 34 000; Temps partiel

Résumé du poste

Avenir Behavioral Health Center is seeking a compassionate Patient Benefits & Eligibility Specialist in Surprise, AZ to help uninsured patients access AHCCCS/Medicaid. The role involves face-to-face interviews, completing applications, and ongoing follow-up through the eligibility process.

The position starts as part-time, hourly, with potential to transition to full-time based on hospital needs and patient volume.

Qualifications

• High school diploma or equivalent required.
• One year of experience in healthcare administration, patient registration, insurance enrollment, Medicaid eligibility, patient financial services, or related field preferred.

Responsabilités

• Meet face-to-face with uninsured or AHCCCS-eligible patients to assess potential eligibility and initiate AHCCCS applications.
• Assist patients with completing and submitting AHCCCS applications through HEAplus or other approved methods.
• Coordinate follow-up, gathering documentation, communicating with AHCCCS/DES, and maintaining application status.

Description du poste

Position:Patient Benefits & Eligibility Specialist

Location: Surprise, AZ

Job Id:526

# of Openings:1

Patient Benefits & Eligibility Specialist

Position Summary

Avenir Behavioral Health Center is seeking a compassionate, detail-oriented Patient Benefits & Eligibility Specialist to assist uninsured patients with obtaining healthcare coverage, primarily through the Arizona Health Care Cost Containment System (AHCCCS/Medicaid).

This position is responsible for meeting directly with newly admitted patients to assess potential eligibility, facilitate application completion and submission, obtain necessary documentation, and provide ongoing follow-up throughout the eligibility determination process.

The ideal candidate will possess documented relevant experience, strong organizational and communication skills, demonstrate patience and professionalism, and be comfortable working face-to-face with individuals receiving acute inpatient psychiatric treatment.

This is initially a part-time, hourly position, with the potential to transition to full-time employment based on hospital needs, patient volume, and organizational growth.

Essential Duties and Responsibilities

1. Patient Engagement and Eligibility Assessment

• Identify newly admitted patients who are uninsured or may qualify for AHCCCS coverage.
• Meet face-to-face with patients on inpatient units or in designated interview areas to assess potential eligibility and initiate the application process.
• Conduct patient interviews to gather demographic, financial, employment, residency, and household information required for AHCCCS applications.
• Explain eligibility requirements, application procedures, and necessary documentation in a clear, respectful, and understandable manner.
• Assist patients who may experience difficulty participating in the application process due to psychiatric symptoms, cognitive limitations, or other barriers.
• Coordinate with nursing and clinical staff to determine appropriate times for patient interviews based on clinical presentation and ability to participate.
• Maintain appropriate professional boundaries and follow all hospital safety protocols during patient interactions.

2. AHCCCS Application Processing

• Assist patients with completing and submitting AHCCCS applications through Health-e-Arizona Plus (HEAplus) or other approved application methods.
• Review applications for accuracy, completeness, and consistency prior to submission.
• Obtain and organize required supporting documentation, including identification, residency verification, income information, and other eligibility-related records.
• Assist patients in obtaining missing documentation when reasonably possible.
• Obtain appropriate signatures, authorizations, and consents in accordance with applicable requirements.
• Coordinate with legally authorized representatives, guardians, or other appropriate parties when necessary and permitted.
• Ensure applications are submitted promptly and in accordance with applicable AHCCCS requirements.

3. Application Follow-Up and Resolution

• Maintain an accurate and organized tracking system for all applications initiated or managed.
• Monitor application status and identify outstanding documentation, verification requests, or other deficiencies.
• Communicate with AHCCCS, the Arizona Department of Economic Security (DES), and other appropriate agencies to facilitate application processing and resolve outstanding issues.
• Conduct follow-up meetings with patients as necessary to obtain additional information or complete application requirements.
• Coordinate appropriate follow-up after patient discharge when necessary and authorized.
• Document eligibility determinations, effective coverage dates, denials, and other relevant outcomes.
• Communicate application progress and final determinations to appropriate hospital personnel.
• Identify and escalat barriers that may prevent timely application completion or resolution.
• Work closely with Intake, Case Management, Nursing, Utilization Review, and Billing to identify patients requiring AHCCCS enrollment assistance.
• Coordinate with hospital departments to obtain relevant information needed to complete applications.
• Provide timely updates regarding pending applications, eligibility determinations, and coverage status.
• Assist with resolving insurance coverage discrepancies directly related to AHCCCS enrollment.
• Support accurate documentation of insurance information within hospital systems.
• Participate in efforts to improve application completion rates, reduce delays, and minimize avoidable uncompensated care.

5. Documentation, Compliance, and Confidentiality

• Maintain accurate, complete, and timely documentation of patient interactions, application activities, and outcomes.
• Protect confidential patient, financial, and personal information in accordance with HIPAA and applicable hospital policies.
• Maintain working knowledge of AHCCCS eligibility criteria, application requirements, and relevant procedural changes.
• Ensure all application information is obtained and submitted accurately and without misrepresentation.
• Respect patient rights, dignity, privacy, and individual circumstances throughout the enrollment process.
• Recognize when a patient's clinical condition may affect their ability to participate meaningfully and coordinate with appropriate clinical personnel.
• Follow all hospital policies, procedures, and applicable state and federal regulations.

6. Additional Responsibilities

• Assist with related patient financial assistance or eligibility activities as assigned.
• Participate in departmental meetings, training, and process improvement initiatives as appropriate.
• Perform other duties as assigned consistent with the position's responsibilities and operational needs.

Minimum Qualifications

• High school diploma or equivalent required.
• One year of experience in healthcare administration, patient registration, insurance enrollment, Medicaid eligibility, patient financial services, or a related field preferred.
• Strong interpersonal and communication skills, including the ability to interact professionally with patients experiencing behavioral health challenges.
• Excellent organizational skills and attention to detail.
• Ability to manage multiple applications simultaneously and consistently follow through on outstanding tasks.
• Proficiency with computers, electronic documentation systems, and standard office software.
• Ability to maintain confidentiality and handle sensitive personal and financial information appropriately.
• Ability to work independently while collaborating effectively with clinical and administrative departments.

Preferred Qualifications

• Experience assisting individuals with AHCCCS/Medicaid applications.
• Familiarity with Health-e-Arizona Plus (HEAplus) and Arizona Medicaid eligibility requirements.
• Prior experience in an inpatient hospital, behavioral health facility, or healthcare financial services setting.
• Knowledge of Medicaid eligibility verification and application follow-up procedures.
• Experience working directly with individuals experiencing psychiatric or behavioral health conditions.
• Bilingual English/Spanish communication skills.

Knowledge, Skills, and Abilities

• Ability to establish rapport with patients from diverse backgrounds.
• Strong interviewing and information-gathering skills.
• Ability to communicate complex application requirements in understandable terms.
• Patience, empathy, professionalism, and sound judgment when interacting with vulnerable patient populations.
• Ability to recognize when patient participation should be postponed or coordinated with clinical staff.
• Strong problem-solving skills and persistence in resolving application-related issues.
• Ability to prioritize workload and manage competing deadlines.
• Ability to work effectively with minimal supervision.
• Commitment to accuracy, accountability, and timely follow-through.

Performance Expectations

Performance will be evaluated based on the employee's ability to:

• Identify and engage uninsured patients in a timely manner.
• Complete and submit accurate AHCCCS applications promptly.
• Maintain consistent follow-up on pending applications and outstanding documentation.
• Keep accurate and current records of application status and outcomes.
• Communicate effectively with patients, hospital departments, and appropriate agencies.
• Demonstrate professionalism and appropriate judgment during direct patient interactions.
• Contribute to improved enrollment outcomes and reduced avoidable uncompensated care.

Performance expectations will account for factors outside the employee's control, including patient eligibility, availability of required documentation, patient participation, and state agency processing timelines.

Work Schedule and Employment Status

This position is initially classified as part-time, hourly, non-exempt, with scheduling determined by hospital operational needs and patient admission volume.

The position requires onsite presence and regular face-to-face interaction with hospitalized patients.

As hospital operations evolve, the position may be considered for expansion to full-time employment based on workload, demonstrated operational need, and organizational approval. Transition to full-time status is not guaranteed.