Financial Eligibility Specialist

Financial Eligibility Specialist

The Financial Eligibility Specialist determines applicant eligibility for third party reimbursement, processes data necessary for admission of new patients into health services, ensures proper coding for insurance billing, and handles inquiries from prospective applicants and patients. Not responsible for Chase Brexton billing discussions or questions that are not related to Sliding Fee charges.

Major Duties and Responsibilities

Analytical and Critical Thinking

• Conducts fee scale and insurance eligibility for clients following procedures and guidelines specific to each program.
• Calculate and implement the Ryan White Cap.
• Review relevant reports and follow up to link patients to eligible insurance and/or assistance programs.

Problem Solving and Decision Making

• Ensure that the client's fee scale is appropriately applied to any other payer source such as Medicare, Medicaid, MADAP, and any other third-party insurance.
• Refer clients to medical case manager should someone be entitled to additional assistance.

Compliance, Policy, and Procedure

• Working knowledge of all Maryland insurance programs and eligibility guidelines.
• Working knowledge of all Chase Brexton policies and procedures.
• Compliance with all expected quality and productivity standards as set by the site Director of Operations, quality team, or their designee.

Workplace Computers and Equipment

• Register clients into CPS and ability to complete Case Management visit note explaining any referrals or plans.

Checking, Examining, and Recording

• Complete all necessary paperwork.
• Maintains up-to-date and orderly eligibility files.
• Provide comprehensive monthly reporting of patient statistics and metrics.
• Responding to billing discussions or questions related to Sliding Fee charges.

Planning and Organizing

• Conducts renewal eligibility as required by each program.
• Participation in workgroups and special projects, as assigned.

Patient Focus

• Confirms eligibility appointments with clients.
• Sets initial service appointments once eligibility has been determined.
• Provides clients with list of required eligibility documentation.
• Refer patients to new Chase Brexton services based on patient treatment needs.

Skills and Abilities

Must become a Certified Application Counselor and complete enrollments through the Maryland Health Benefits Exchange within three (3) months of hire. Required: Ability to understand and practice bookkeeping and accounting terminology. Required: Ability to operate computers and other office machines. Cultural competence and the ability to work with providing individualized care that respects and empowers patients of all ages, races, gender identities, religions, sexual orientations, ethnicities, and socioeconomic statuses. Providing care that honors, affirms, and supports each patient is at the core of everything we do. Bilingual preferred. Must be able to take responsibility and work under pressure.

Education and/or Experience

High School Diploma or GED. Required: Certified Application Counselor designation within three (3) months of hire. Required: At least three (3) years of experience with insurance verification and/or sliding fee scale determination. Training or background in ICD-A / CPT codes preferred. Knowledge of insurance and billing practices preferred.

Working Conditions/Physical Demands

Work is typically performed in an office environment. The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Chase Brexton Health Care