Eligibility Coordinator

POSITION SUMMARY

The Eligibility Coordinator is responsible for assisting, greeting, and directing patients in person or by telephone. This role identifies the purpose of each visit or call and courteously directs individuals to the appropriate staff member or community resource. The Eligibility Coordinator verifies registration status, determines potential eligibility for Covered California, local, state, and federal insurance programs, including CalAIM services, and assists clients in completing or referring required eligibility documentation. Will reach out to Health Plan as needed. Additionally, the Eligibility Coordinator manages inventory, communicates with health plans, verifies eligibility, and coordinates orders, including office supplies as needed. Responsibilities also include photocopying required forms, filing records within the EHR / Document Management System, updating EHR messages, completing EHR templates, reaching out to patients, and preparing other necessary documentation. The Eligibility Coordinator enters demographic and historical data into the NextGen Practice Management System and verifies health insurance eligibility and / or authorizations to ensure accurate and complete patient records.

Essential Duties, Functions, and Responsibilities

Serves as the primary CalAIM Operations contact for Fresno American Indian Health Project.

Answers incoming calls, directs patients appropriately, and documents interactions accurately in the EHR.

Instructs and assists clients with completing the intake and registration process.

Pre-screens clients for eligibility for Enhanced Care Management (ECM), Community Supports (CS), and payer programs, referring them to the appropriate office or assisting directly with applications as applicable.

Verifies health insurance eligibility.

Completes Covered California eligibility requirements and testing and assists patients with enrollment into programs and / or health plans.

Enters client eligibility and demographic data into the NextGen Practice Management System accurately, completely, and in a timely manner.

Collects required intake documentation and ensures copies are maintained in the patient file.

Scans, uploads, and files paperwork into the appropriate patient or organizational records.

Assists with patient chart audits to ensure eligibility documentation is complete and accurate.

Maintains inventory of office forms and assists with the ordering process as needed.

Participates in required CalAIM and other assigned meetings and prepares meeting notes as requested.

Keeps the CalAIM Manager informed of ongoing activities, pending issues, and potential concerns.

Participates in agency-wide outreach efforts with the community, community agencies, managed care plans, and other payers.

Adheres to agency policies and procedures and supports the mission and goals of FAIHP.

Maintains strict confidentiality of client and personnel information in compliance with HIPAA, professional codes of conduct, State of California regulations, the Privacy Act, and FAIHP policies and procedures.

MINIMUM REQUIREMENTS :

EDUCATION :

• High School Diploma or GED required
• Some College or a College Degree is preferred
• Minimum of 2 years of experience as a patient advocate, social services coordinator, or similar role.
• Experience engaging with the American Indian / Alaska Native community is highly desirable.

EXPERIENCE :

LICENSE / CERTIFICATIONS :

SKILLS :

A clear background check, drug screen, and negative TB screen are necessary for employment.

FAIHP offers a robust benefits package that includes :

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