Eligibility Specialist

POSITION SUMMARY:

Assist clients with registration and program eligibility paperwork and provide follow-up support on eligibility. Assist patients with appointment scheduling. Cross train for all patient access responsibilities.

DUTIES AND RESPONSIBILITIES:

1. Interviews patients or authorized representative to gather information while determining eligibility for San José Clinic services.
2. Spend most of the workday reviewing and organizing files and papers. Organization and attention to detail are extremely important.
3. Obtains, verifies, and calculates income and resources to determine patient sliding-fee level eligibility.
4. Ensure program eligibility forms are completed as required.
5. Provide clients with list of required eligibility documents.
6. Provide information and educate patients on clinic procedures relative to contributions for San José Clinic services.
7. Performs data entry of eligible clients into electronic system.
8. Obtain client information by answering telephone calls, interviewing clients and verifying information. Contacting customers will be necessary to gather necessary information and explain outcomes.
9. Scans all necessary demographic, financial information, consents and other missing documents required for registration and to properly determine San José Clinic eligibility.
10. Monitor pending applications to ensure they are completed on a timely basis. Follow up with patients daily to close out pending applications.
11. Respond to client email inquiries, and other non-phone inquiries/communications.
12. Refer patients to community service organizations as needed.
13. Coordinate with patient access team members regarding eligibility status updates.
14. Manages a high volume of applications and data entry daily. Enters all data into Athena accurately and in the required timeframe.
15. Complete monthly reporting and maintain eligibility status records in Excel.
16. Maintain up to date and orderly eligibility files.
17. Attends community outreach events as assigned.
18. Cross train for all patient access responsibilities.
19. Attention to detail and a positive attitude are keys to success in this position.
20. Prioritizes and completes all work in an accurate, effective and efficient manner.
21. Follows all HIPAA and OSHA guidelines and regulations, including assisting HIPAA and OSHA Officers in ensuring compliance.
22. Maintains confidentiality of patient information/records at all times.
23. Maintains established San José Clinic policies, procedures, objectives, quality assurance, safety, environmental and infection control.
24. Implements job responsibilities in a manner that is consistent with the San José Clinic Mission and Code of Conduct and is supportive of San José Clinic cultural diversity objectives.
25. Build and maintain positive working relationships with team members, other departmental employees, and the public utilizing principles of effective customer service.
26. Performs other duties as assigned.

Benefits:

• Medical, dental, and vision
• 401(K) 4% match
• 19 PTO days
• Floating holiday
• DEI day
• 11 paid holidays
• Group life insurance
• Voluntary life insurance
• Short term disability
• Long-term disability

Start Date: 5/20/2024

QUALIFICATIONS, EDUCATION AND EXPERIENCE:

1. High school diploma or equivalency; college degree preferred.
2. Bilingual English/Spanish required.
3. Minimum one to three years' experience in a medical office including at least one year of relative experience.
4. Must be comfortable working with financial documents (tax returns, pay stubs, etc.) and evaluating them relative to program eligibility.
5. Proficiently use the computer medical management software entering and updating patient information as required, including, daily input of patient and insurance information.
6. Proficiently use the electronic medical records software entering and updating patient information as required, including, daily input of patient and insurance information.
7. Excellent communication skills
8. Knowledge of standard office policies and procedures.
9. Knowledge of insurance eligibility requirements.
10. Skill in organizing time and managing multiple demands.
11. Skill in dealing with patients and visitors as well as other staff members.
12. Ability to work independently and use good judgment in work prioritization.
13. Ability to complete difficult/complex tasks.
14. Ability to follow oral and written instructions.

PHYSICAL REQUIREMENTS:

1. Ability to sit, stand, bend, and stoop for (long) periods of time.
2. Ability to exert up to 50 pounds of force occasionally/frequently.
3. Ability to work in a stressful environment.
4. Ability to respond to emergencies/crises.
5. Exposure to noise.
6. Exposure to blood and/or body fluids.