Eligibility Specialist

I. Position Function SUMMARY:

Under the general direction of the Medical Billing Supervisor, the Eligibility Specialist assists individuals and employees in applying for coverage with the Medicaid insurance program, Sliding Fee Scale program, and/or payment plan. They will make eligibility determinations for the Sliding Fee Scale program. The position will work closely with billing staff for the timely completion of billing functions. The Eligibility Specialist will work closely with the front office and billing staff to insure accurate and timely information.

II. ESSENTIAL DUTIES AND RESPONSIBILITIES

This position may have various work assignments within HICHC. This description is intended to be generic in nature, and as such it does not detail all of the duties and responsibilities of a particular job assignment. It is not intended to determine specific duties and responsibilities of any particular position, and essential functions and overtime eligibility may vary based on the specific tasks assigned.

Provide information to individuals, families, and/or small businesses on financial assistance programs and coverage options.

• Assist individuals and employees in applying for coverage with the Medicaid insurance program, Sliding Fee Scale program, or payment plan.
• Interview applicants, clients or other representatives to acquire detailed personal or confidential information.
• Initiate a total-household assistance interview to determine eligibility for financial assistance.
• Refer patients to outreach employees for further assistance, when needed.
• Review computer reports in order to update caseload eligibility and manage workflow.
• Assist in developing and updating patient financial review packet to expedite patient financial interviews.
• Communicate with front desk personnel regarding patient information needed via spreadsheet and/or via patient and account notes within Intergy.
• Prepare monthly and weekly reports as requested.
• Communicate and work closely with front office staff.
• Other duties as assigned.

III. POSITION QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience

High School graduate or GED certificate and two years related experience and/or training in medical billing is required; OR any equivalent combination of experience, training and/or education.

Knowledge, Skills and Abilities

This position requires:

• Ability to use a computer to enter patient data and retrieve information in a patient billing system.
• Ability to use Microsoft Office Word and Excel.
• Knowledge of collections procedures.
• Detail oriented with demonstrated organizational skills in creating and maintaining file system.
• Experience with basic bookkeeping and general office procedures to include filing, copying, and faxing.
• Ability to work on multiple tasks within established deadlines.
• Ability to work under the direction of a supervisor and follow instructions.
• Good management of time.

Language Skills:

• Ability to read and interpret documents such as government regulations and guidelines, payer contracts, patient records, operating and maintenance instructions, procedure manuals, etc.
• Ability to write at a level of competence, including internal reports and memoranda.
• Ability to communicate effectively with diverse groups of people to include staff and providers and patients.
• Ability to communicate effectively with patients and their families to make their visit a pleasant experience.
• Sensitivity to the multicultural nature of the service area population and may be required to communicate in another language.

Personal Characteristics

Personal characteristics to include: a team player, high integrity, communication and customer relations skills, regular work attendance, courteous and friendly, able to work well with diverse groups of people, and gain and maintain respect of others.

Confidential and Sensitive Information:

Because the employee has access to personal and professional data regarding individual employees and their families, personal data regarding individual patients and the families, and/or sensitive company financial data, an essential job result is the maintenance of a high level of confidentiality of the information processed by the employee. Violation of this confidence may result in disciplinary action, including termination of employment.

IV. PHYSICAL CHARACTERISTICS/WORKING CONDITIONS

General Remarks: The work environment described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential tasks and functions.

Environment: The noise level in the work environment is usually low to moderate. There are no known environmental hazards on the premises. Work environment is often stressful. Work is mostly inside, and normal office Specialist safety precautions and practices are required. Incumbent may be exposed to patients' conditions and some-unpleasant sights, smells and contagious diseases including virus, disease and infection from patients and specimens in working environment. All employees are offered the opportunity to receive the Hepatitis B vaccination series.

Equipment Use: Frequent use of telephone system and office equipment including but not limited to computer, printer, facsimile machine, copier and general office supplies. Occasional use of wheelchair, gurney and other assisted devices for patient transfers in the clinic.

Work Hours: Forty hour work weeks. Overtime may be required.

Mental Demands: Duties require attention to detail, alertness, problem solving, tolerance to stress and exercising sound judgment. Duties require high tolerance and adequate coping skills for dealing with loss, grief and bereavement. Good stress reduction and management skills are essential.

VII. REMARKS:

The foregoing position description is not all-inclusive of the duties that may be assigned to the employee. In order to ensure maximum flexibility and efficiency and to encourage cross training, employees will be assigned additional duties as deemed necessary or desirable by HICHC.