Eligibility & Enrollment Specialist

Job Description: Eligibility & enrollment SpecialistReports To: Front Office Supervisor

Status: Full-Time, Non-Exempt

Position Summary: This position is responsible for helping clients enroll in health insurance programs; registering new and established patients in IHC services; conducting outreach to established clients at the Indian Health Center (IHC); assisting patients develop payment plans; and backing up the front desk. The IHC is a Patient Centered Health Home and all employees are an integral part of this model of care delivery.

Duties & Responsibilities:

• Meet with new and established medical clients to inform them about the services offered at the IHC and to enroll them into health insurance programs or any available County coverage
• Greet patients in waiting room and help them to complete forms
• Conduct outreach calls to all of the IHC’s American Indian clients and encourage them to come in and receive services
• Conduct outreach calls and mailings to new medical managed care enrollees
• Create an incentive system aimed at reducing the number of no show clients
• Provide back up to the receptionist and medical records when needed
• Develop payment plans if needed for clients
• Compile monthly statistics for the Medical Department’s Board Report
• Will need to prepare the Eligibility report for registration
• Make new patient registration packets
• Confirm appointments
• Check voicemail daily, follow up with calls and make new patient appointments
• Maintain schedule for Medi-Cal eligibility worker
• Assist patients with Medi-Cal applications
• Assist eligible applicants with the Covered California enrollment process
• Will attend outreach events as needed
• Participate as a proactive representative of the Patient Centered Health Home
• Perform duties utilizing the Team-Based Approach
• Perform other duties as assigned

Required Qualifications, Knowledge and Abilities:

• Associate degree in a medical related field or comparable
• A minimum of 2 years of experience in a medical setting in a similar position
• Able to read, write and speak English fluently
• Bi-lingual in Spanish preferred
• Knowledge of medical terminology, procedure codes, ICD-9 codes, and medical records handling
• Trained as Certified Enrollment Counselor for Covered California or willing to complete training within 3 months of being hired
• Vast knowledge of Federal and State health programs, and Qualified Health Plans of Cover California
• Working knowledge of computer programs such as Microsoft Window
• Experience with Electronic Health Records and patient registries
• Flexibility, initiative, reliability, and creativity
• Willingness to cross train for reception and medical records
• Excellent customer service
• Knowledge of and ability to relate to the American Indian community and other minority populations
• Possession of a valid California Driver License, automobile insurance, and a clean driving record. Will need to provide this at time of hire
• Ability to maintain strict confidentiality
• Ability to function independently and as a team member within diverse environments as well as with a diverse staff composition
• Demonstrated ability to perform multiple administrative functions simultaneously in an accurate, organized, and efficient manner. Ability to multitask and thrive in a fast-paced, constantly changing environment
• Ability to carry out all responsibilities in an honest, ethical and professional manner and demonstrate good judgment

Physical Requirements:

• Ability to sit, stand and walk for extensive periods of time
• Manual and finger dexterity and eye-hand coordination sufficient to accomplish the duties associated with your job description
• Ability to lift up to 35 pounds
• Ability to stoop, squat, or bend frequently
• Corrected vision and hearing within normal range to observe and communicate with patients and professional staff

Working Conditions:

Exposure to all patient elements, including communicable disease and blood borne pathogens. Will be working in a fast paced medical environment which can be stressful and constantly changing conditions. Normal working hours are from 8:00 am until 5:00 pm with one hour for lunch. However, working hours may vary depending upon need. Will need to be flexible in performing tasks with limited discretion in making judgment decisions.

Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than above, the Indian Health Center of Santa Clara Valley, Inc. is an equal opportunity employer including minorities, women, disabled and veterans.

Approvals/Acknowledgements