Patient Services Specialist II

Job Description

Job Description

Position: #700326

Department: Health Services

Reports to: Senior Manager of Benefits and Enrollment

Shift Differential Premium: $1.75 per hour for hours worked between 6pm-6am

Schedule: Monday-Thursday 10:00am – 7:00pm, Friday 8:30am-5:30pm

Status: 100%, Full-Time, Non-Exempt, Union

Probation: 90 days

Benefits: Medical, Dental, Vision; also including Life Insurance, Long-Term Disability, Employee Assistance Program, and a 403(b) Retirement Plan

Center’s Mission:

Building a world where LGBT people thrive as healthy, equal, and complete members of society.

DEPARTMENT SUMMARY: As the nation’s largest and most experienced provider of LGBT medical and mental health services, we help LGBTQ people lead healthier, happier lives, by keeping their minds and body well. All services are free or low cost. We’re also one of the few Federally Qualified Health Centers in the nation with providers who specialize in primary care for LGBTQ people and with a research team working to advance the care and treatment of people in our community.

JOB SUMMARY: Under the direction of the Senior Manager of Benefits and Enrollment, the Patient Services Specialist II will be responsible for providing direct enrollment, navigation and linkage into insurance programs, social services benefits, and Center programs. They are also responsible for ensuring patients retain insurance and care as they move seamlessly between insurance/benefits plans. 

ESSENTIAL FUNCTIONS: 

• Assist and directly enroll new and established patients in person, by phone, text, and/or email into payers including but not limited to Medi-Cal, Covered California, ADAP, Ryan White, MHLA, OA-HIPP, EB-HIPP, and PrEP AP.

• Assess/review patients’ eligibility for private and/or public insurance coverage using technology platforms.

• Create and monitor client caseload reports to ensure established patients are not falling out of care due to loss of insurance.

• Provide information to clients via telephone, in-person and through technology platforms regarding the Medi-Cal, Covered California, ADAP, Ryan White and other payers.

• Perform outreach to patients who have lost insurance coverage, particularly Medi-Cal, to re-establish eligibility.

• Assist with out-of-pocket claim filing for medical care that meet ADAP guidelines as needed.

• Review patient documentation for completeness and accuracy to ensure program enrollment meets guidelines.

• Ensure patient information is entered correctly into data systems including Covered California, BenefitsCal, One E-App, Casewatch, EHR, Practice Management system, and the ADAP portal.

• Use patient population health management reporting tools (ex., i2i and Phreesia) to build data queries to identify and reach out to patients who have insurance expiration dates approaching.

• Maintain and upload documentation for the Medi-Cal, Covered California, MHLA, BenefitsCal, One E-App, ADAP and Ryan White programs consistent with program requirements.

• Interface with the pharmacy staff to ensure patients stay engaged in care through benefits enrollment.

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