Eligibility Specialist

Description

POSITION SUMMARY

The Eligibility Specialist is responsible for promoting health insurance programs through coordinated comprehensive and effective outreach efforts. Will greet incoming patients/clients, screen for medical coverage eligibility available through different programs and assist with the application process, register patients, and provide information regarding Adelante Healthcare, Inc. Will attend outreach events and promote Adelante Healthcare services. Work is performed under the direct supervision of the Eligibility Manager at each site.

EXPECTATIONS

Every Adelante Healthcare employee will strive to maximize their performance and contribution to Adelante Healthcare and the community we serve every day. Employees are expected to work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and the highest standards of personal integrity, professionalism, and competence.

OUR CORE VALUES

• Inclusion

• Nurture

• Service

• Purposeful

• Integrity

• Resilient

• Engaged

Qualifications

ESSENTIAL SKILLS AND EXPERIENCE:

• Certification to perform cardiopulmonary Resuscitation for the Health Care Professional (CPR) and AED through courses that follow the guidelines from the American Heart Association and Red Cross (cognitive and skills evaluations)

• Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety for all specialty behavioral health locations

• High School Diploma or GED from an accredited institution

• Minimum one (1) year experience in medical front office, customer service and/or experience in sales, interview techniques, and extensive public relations/contact work

• Experience and knowledge of health care programs available through state and federal programs such as Medicaid/AHCCCS, DES, etc.

• Bilingual English/Spanish. Must have the ability to communicate effectively with monolingual Spanish speakers

• Ability to write routine reports and correspondence, utilizing excellent English, spelling, and punctuation skills

• Ability to calculate figures and amounts such as discounts, interest, and percentages

• Ability to interpret a variety of instructions furnished

• Strong familiarity with human service agencies serving low-income and minority populations and understanding of and sensitivity to issues of concerns to low-income and minority communities

• Ability to meet and deal effectively with clients, associates, and the general public

• Basic computer efficiency, with the ability to utilize the Patient Management system

• Valid AZ driver’s license

• Ability to drive to any of our locations and other areas in Maricopa County to cover at other sites and provide outreach.

• Competency in dealing with people of various cultures and backgrounds

POSITION REPONSIBILITIES

• Welcome patients and provide information on health care programs. Greet patients/clients, screen for appropriate medical coverage eligibility available through state programs, and assist patient/client in application process for medical programs, track applications in progress for completion by continued contact with patient/client and assist patient/client with problem application

• Register patient/client with Adelante’s health center for primary health care and promote and register patient/client for other available programs within Adelante’s facility

• Assure patients are registered under correct eligibility and corresponding pay code.

• Accurately update patient records accordingly for eligibility. Maintain current status of work in progress with accuracy and productivity at measured benchmarks

• Guide and assist patients/clients in utilizing recommended services as indicated by medical referral and make appropriate referrals to community agencies on a case by case basis. Orient patients/clients to care delivery system and available resources.

• Share pertinent information regarding health programs

• Drive to various locations in Maricopa County, including, but not limited to, other Adelante Healthcare facilities to provide outreach and eligibility services

• Present to other community partners on what services Adelante Healthcare offers

• Attend community outreach events to promote Adelante Healthcare services

NONESSENTIAL SKILLS AND EXPERIENCE:

• Associates Degree from a two year college in a health care or related field

• Three (3) years of experience in community health

Additional Duties and Responsibilities

• Other duties as requested or assigned

Patient Centered Medical Home (PCMH) and Integrated Care Team (ICT)

All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team-based model to promote wellness and improve health outcomes.

Adherence to Compliance and Code of Conduct

All employees are required to comply with Adelante Healthcare’s written standards, including its Compliance Program and Code of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelante’s legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.

In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.