Patient Eligibility Specialist

First Choice Community Healthcare INC; Albuquerque (NM); On-site; USD 32,000 - 46,000; Full time

Job summary

First Choice Community Healthcare INC seeks an Patient Eligibility Specialist to determine eligibility for healthcare funding programs, including Medicaid/Medicare, NM Health Insurance Exchange, and related plans. The role involves community outreach, patient education, and assisting with applications.

Under supervision, you will verify eligibility, update records in the PM system, and ensure high levels of customer service while meeting enrollment quotas. Some evenings/weekends may be required.

Qualifications

• High School graduate or GED required.
• At least two years related experience and/or training.
• Bi-lingual English/Spanish preferred.

Responsibilities

• Provide accurate information about health insurance coverage under the ACA to patients and the public.
• Conduct outreach and education in clinics and community settings, including evenings and weekends as needed.
• Explain and assist with eligibility determination and applications for Medicaid, Medicare, NM Health Insurance Exchange plans, and related programs.
• Verify insurance eligibility for Medicaid, Medicare, and third-party payors with proper documentation.
• Update patient records in the practice management system with income and insurance details.
• Ensure customer satisfaction and high-quality service for FCCH customers.
• Meet monthly enrollment quotas for grant reporting.
• Answer calls, route to appropriate offices, and refer callers to other agencies when FCCH cannot meet needs.
• Schedule appointments by phone and in person using the PM system and other needed software.
• Perform other duties as assigned.

Skills

Bilingual English/Spanish

Customer service

Interpersonal skills

Microsoft Office

Data entry

Education

High School Diploma or GED

Tools

Practice management system

Office software

Job description

Job Title Patient Eligibility Specialist Position Code: B03N

Salary Grade: D Non-Exempt

Department: Health Center Operations

LOCATION: Health Centers

Union Exempt: No

The following statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

Position Summary

Under the close supervision of the Outreach and Enrollment Program Manager or Health Center Manager, as applicable, the eligibility specialist works with patients and the public to determine eligibility for various healthcare funding programs, in a manner that is supportive and responsive.

Essential Duties and Responsibilities

Patient Outreach/Eligibility:

• Provide accurate and impartial information to patients and the general public about health insurance coverage available to them and their families under the Affordable Care Act.
• Conduct outreach and education activities in clinics and in community settings and door-to-door (as appropriate) on weekdays, weekends and evenings, as scheduled, to meet community needs.
• Explain and assist existing patients and the general public with eligibility determination and application for various healthcare financial assistance and/or insurance programs, including all forms of Medicaid, Medicare, UNM Care, NM Health Insurance Exchange plans; Title X, BCC, CRC, Title V, and sliding fee discounts.
• Verify insurance eligibility for Medicaid, Medicare, and third party payors, ensuring that all documentation has been accepted by HSD or other agencies.
• Update patient records in the practice management system including income and insurance information.
• Provide information to patients and the general public concerning functions of FCCH, ensuring customer satisfaction and the highest level of customer service.
• Ensure that monthly quotas for enrollment are met and documented for grant reporting.
• Answer the telephone and connect callers to the appropriate offices or individual staff, as necessary. Refer callers to other agencies when FCCH cannot meet needs.
• Schedule appointments over the telephone and in person using the practice management system and other software as needed.
• Other Duties, As Assigned.

Requirements

MINIMUM EDUCATION AND EXPERIENCE

• High School graduate or GED certificate
• At least two years related experience and/or training is required.
• Bi-lingual English/Spanish is preferred.

LICENSES/CERTIFICATIONS REQUIRED

• Obtain within first 6 months of hire/maintain a Presumptive Eligibility Determiner Number.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

• Comfort working with people one on one and in giving group presentations
• Proficiency using the Internet and various software programs and computers
• Proficiency using a laptop, wireless card, mobile scanners and cell phones
• Good interpersonal communication skills and ability to establish a sense of trust while also maintaining professional relationship
• Basic knowledge of health insurance and the health 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 different learning styles and needs of clients
• Ability to work independently, and as part of a team, in the field and in office settings
• Ability to manage time and priorities effectively and to meet deadlines
• Ability to work on multiple tasks and to be flexible with schedule and assignments
• Ability to work under the direction of a supervisor and follow detailed instructions
• Ability to take the initiative to resolve patient concerns and problems
• Ability to travel outside the county on a daily basis if needed
• Knowledge and familiar with compliance program, corporate fully and comply with laws and regulations.

Age of Patients Served

• All

Physical Characteristics/Working Conditions

A person in this position has to be able to prioritize and respond to the diverse demands of the position. There are frequent opportunities to relax from any physical exertion, change position in work activities, or break from computer application tasks.

• Physical Effort and Dexterity: Good dexterity to operate personal computer and office equipment. Occasional lifting and carrying related to office duties.
• Machines, Tools, Equipment required to be operated: Capable of using office machines and personal computers for word processing, data entry and spreadsheet applications.
• Visual Acuity, Hearing, and Speaking: Must be able to read a computer monitor and outputs accurately. Must be able to communicate clearly and accurately for work and safety compliance.
• Environment/Working Conditions: Work is mostly inside an office in a controlled environment. Normal office safety precautions and practices are required. Position requires travel throughout the Greater Albuquerque metropolitan area. Work schedule will include some weekends and evenings.