Eligibility and Financial Screening Specialist

Healthcare Eligibility Specialist

Under general supervision, this role combines eligibility determination, financial screening, application assistance and enrollment services for local, state, and federally funded healthcare programs. This position is responsible for interviewing applicants, collecting and verifying required documentation, enrolling eligible individuals in appropriate programs and submitting state and federal applications for coverage. This position will assist patients/clients in-person, virtually, or by phone and will process applications submitted online or by mail and is responsible for maintaining accurate client records. This position requires exceptional customer service skills and the ability to navigate complex systems and compliance standards.

Responsibilities

Essential Duties:

• Interview applicants via video visits, phone calls, and in person in a professional manner to obtain demographic, financial, and household information.
• Screen and determine eligibility for local, state, and federal healthcare coverage programs and specialty funded programs and grants.
• Accurately apply the Eligibility Policies and Procedures to determine client eligibility and enroll eligible clients into the appropriate local and grant programs, and assist clients with submitting applications for state and federal health coverage programs.
• Maintain client files and contacts, and accurately enter data into eligibility databases and EMR systems.
• Submit, assist, and troubleshoot state and federal program applications.
• Educate clients on available programs, benefits, and services both in person and via phone or email.
• Answer incoming calls regarding Eligibility services and make outbound calls as needed.
• Attend community events and represent the organization as needed, including evenings and weekends.
• Identify and refer clients to additional services and community resources.
• Attend training and review all emails, newsletters and documents in order to stay current with changes in laws, regulations, and program eligibility requirements.
• Uphold the organization's values by consistently demonstrating professionalism in all actions, job performance, personal conduct, and communications.
• Perform other related duties as assigned.

Knowledge/Skills/Abilities:

• Strong interpersonal and customer service skills.
• Bilingual (English/Spanish) highly preferred.
• Proficiency in data entry and use of EMR, Microsoft Office Suite, Excel, and Adobe Pro.
• Know how to find information and ability to analyze information and evaluate results to choose the best solution.
• Knowledge of financial eligibility processes, regulatory standards, and specialty grants (Ryan White, Title V, PHC, Family Planning).
• Conflict resolution, problem-solving, and critical thinking abilities.
• Ability to work effectively with diverse populations and adjust actions based on client needs.
• Ability to multi-task and maintain attention to detail under pressure.

Qualifications

Education:

• High School Diploma or equivalent required.

Experience:

• 3 years Experience working in health care, government, non-profit, or a customer service industry.