The Patient Eligibility and Enrollment Specialist reaches out to uninsured persons receiving care at CHC and those living in the local service area and establishes linkages to CHC clinics and health insurance. This position will work to provide outreach opportunities for community residents who lack access to healthcare and health insurance and provide patient related services regarding enrollment and eligibility for various payers; assists patients in completing applications on-line and qualifying for sliding fee discounts. Coordinates with outside caseworkers to enable qualified clients to enroll in Medicaid services or other appropriate public health programs and services.
Knowledge, Skills & Abilities
- Reads, speaks, understands and writes proficiently in English.
- Independent and self-directed.
- Works effectively in a team environment.
- Problem-solves with creativity and ingenuity.
- Organizes, prioritizes, and coordinates multiple activities and tasks.
- Works with initiative, energy and effectiveness in a fast-paced environment.
- Produces work in high quantity and quality.
- Remains calm and effective in high pressure and emergency situations.
- Use of multi-line telephones and other office machines.
- Knowledge of medical terminology.
- Proficiency in the use of Microsoft Office applications; Word, Excel and Outlook.
- Possess ability to write routine reports and correspondence.
- Knowledge of dental terminology.
- Bilingual skills.
- Knowledge of the health and human services infrastructure, health insurance programs and public coverage options.
- Keyboarding: 35 wpm with a 95% accuracy rate.
- High school graduate or equivalent.
- Graduate of an accredited Medical Billing Certificate program or in lieu of certificate, a combination of equivalent education and work experience.
- Customer service related experience working with the general public (1 year).
- Working with insurance/billing in a healthcare setting/insurance organization.
- ICD-9 coding experience.
- CPT-4 coding experience.
- CDT-5 coding experience.
- Healthcare information systems, such as electronic health record and practice management systems experience.
- Working with low income, multi-ethnic populations.
- Working with private and/or government third party reimbursement.
Job Specific Functions/Performance Expectations:
1. Be a resource for staff on all aspects of the insurance programs and sliding fee discounts.
2. Verifies insurance coverage for future scheduled appointments using practice management system appointment reports.
3. Provide enrollment assistance for uninsured patients to access subsidized, low-cost and free health insurance programs through the health insurance marketplace, Medicaid and the Children’s Health Insurance Program (CHIP).
4. Assists patients in completing applications and qualifying for sliding fee discount program.
5. Assist patients in completing coverage applications, gathering required documentation and solving issues that may arise during the enrollment process.
6. Follows up on outstanding sliding fee applications and enters tracking data into sliding fee database.
7. Provide structured patient education on health coverage, engage in follow up conversations and offer renewal assistance for enrolled individuals.
8. Coordinates with caseworkers to enable qualified clients to enroll in Medicaid services or other appropriate public health programs and services.
9. Maintains Breast and Cervical Health Data Base, works with Provider to ensure all necessary paperwork is completed and verifies patient eligibility.
10. Researches patient questions regarding accounts/statements and initiates appropriate adjustments.
11. Assist and educate patients as new insurance options come available, identifying the affordable coverage that best meets their needs.
12. Distribute outreach materials to patients, community members, partner organizations and businesses to build insurance coverage option awareness.
13. Attend and successfully complete all required training programs; participate in ongoing conference calls, webinars and other professional development opportunities.
14. Adheres to attendance standards in order to perform the job functions for daily operations and/or continuity of patient care.