United Health Centers of the San Joaquin Valley

Enrollment and Eligibility Specialist

Job Locations US-CA-Fresno-Milburn
Posted Date 1 month ago(2/26/2020 5:13 PM)
Job ID
2020-1564
# of Openings
1
Category
Eligibility & Enrollment

Overview

The Enrollment and Eligibility Specialist plays an important role in helping children and families enroll in the Medi-Cal Program. In addition to helping families complete and submit the on line applications, the Enrollment and Eligibility Specialists also keep families informed about program changes and help them maintain their health coverage. They also help families who do not qualify for the Medi-Cal Program by referring them to other available programs. Additionally when not performing enrollments, the position is responsible for the efficient and effective scheduling of site appointments. Answer incoming telephone calls from patients and physician offices calling to schedule Medical, Dental, CPSP, Behavioral Health and Health Education appointments. Plans, organizes, monitors and reports as necessary. Confirms appointments per established protocol. Secures patient information for charting, billing and record keeping purposes. Ensures that established information is obtained in order to pre-register patients.

Responsibilities

This non-exempt position is directly responsible for supporting the sites by improving UHC's central operations through new enrollments and recertification's, monitoring errors, and correcting issues. The Enrollment and Eligibility Specialist works closely with the Enrollment Specialist Supervisor to this end and is familiar with the screening and evaluative processes necessary to determine a patient's eligibility for Medi-cal, (including Medi-cal Dental and presumptive eligibility), Family PACT, CDP & Healthy Families.

  • Assist applicants in properly completing the application. Answer questions.
  • Ensure the confidentiality of all applications, records, and any information received in written, graphic, oral, or other tangible forms.
  • Review and explain the documents that are required with the application.
  • Refer applicants, when necessary, to the county Department of Social Services (DSS) for Medi-Cal if they need more information or assistance with complex issues or other programs
  • Assist applicants in estimating their monthly premiums.
  • Overall knowledge of the revenue cycle process, registration, insurance verification, precertification, billing compliance, payer contracts, patient estimation, financial assistance.
  • Schedules, educates, registers, verifies and estimates services for the patient, updates insurance and demographic information.
  • Answers incoming calls on a multi-line phone.
  • Makes outbound calls to confirm and obtain pre-registration information.
  • Promptly and courteously answers and screens phone calls for the department; routes call as appropriate within established customer service guidelines; accurately records messages and delivers to the appropriate party in a timely manner; checks voicemail frequently. 
  • Providing outstanding customer service to internal and external customers 
  • Reporting any potential customer concerns or complaints immediately to management 

Qualifications

EDUCATION AND LICENSE/CERTIFICATION:

  • Certified Enrollment Counselor (CEC) preferred
  • High School Graduate or equivalent

PRIOR EXPERIENCE:

  • Minimum 2 years of experience in a health center setting as Health Care Associate and/or Certified Enrollment Counselor.
  • Demonstration of strong understanding of patient billing, front office processes and patient intake.

SKILLS

  • Bilingual (secondary language preferred)
  • Able to quickly build and maintain rapport with peers, patients and providers; team player
  • Customer-service oriented
  • Positive professional insight
  • Flexibility and dependability
  • Demonstrated good problem-solving skills; sound judgment.
  • Modern office practices and procedures including email, strong computer skills
  • Attention to detail and excellent follow-through on work tasks
  • Able to handle multiple tasks simultaneously

 

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