Certified Eligibility Specialist II

Position Summary:

Under the supervision of the Patient Services and Eligibility Supervisor, the Eligibility Specialist II will provide clinic in-reach, eligibility education, enrollment navigation and retention assistance aimed at support individuals/families in obtaining and retaining health care coverage.

Essential Functions of the Job:

• Assists individuals and families in applying for and retaining health coverage by collecting required and accurate personal and demographic information; determining eligibility; assessing needs; providing accurate information regarding health coverage options; uploading/submitting verification documents and completing applications.
• Complete and submit health coverage applications, presumptive eligibility applications, and gateway applications. Initiate and maintain proper follow-up with patient and government agency to ensure timely processing and completion of all mandated applications and accompanying documentation.
• Monitors and initiates health coverage redetermination/renewal process for patients. Completes Medi-Cal Renewal Package, CCA Renewal Process, Reports all changes on active accounts, Medi-Cal Add-Ons, New Born Referrals.
• Facilitates referral to SYH and community resources for assistance with other needs and intricate issues.
• Maintains accurate and thorough records of all activities. Prepares statistical reports and patient/client correspondence.  Submit monthly report by the 1st of every month.
• Provides responsive, high quality service to patients, SYH employees, representative of County and outside agencies and members of the public by providing accurate, complete and up-to-date information in a courteous, efficient and timely manner.
• Provide follow-up activities as needed to ensure families obtain and retain health coverage. A high focus will be on assisting high-acuity patients requiring more intensive assistance (i.e. senior, child or adult with disability) to ensure there is no lapse in coverage.
• Conducts clinic in-reach. Outreach and education activities, individually and in group, to SYH patients and community members at clinic locations and other community locations about SYH services and programs, public health assistance programs, health insurance options, voter information/registration and policy issues impacting the community.
• Supports PS&E Supervisor with on-site training for new staff when requested. Following proper procedures and training templates provided by Eligibility Supervisor.

Additional Duties and Responsibilities:

• Complies with all department, organization and government policies & procedures.
• Attends meetings and trainings as required.
• Provides CES coverage as needed.
• Performs other related duties as assigned or requested.

Job Requirements

Experience Required:

• A minimum of one year of experience performing eligibility insurance or billing experience

Education Required:

• High School Diploma or GED equivalent
• Related education may substitute for experience

Certifications/Licenses Required:

• Certified Enrollment Counselor (CEC) exam.
• SYH Eligibility competency exam within 90-day probationary period

Verbal and Written Skills Required to Perform the Job:

• Must have excellent oral and written communication skills
• Bilingual (English/Spanish) is required

Technical Knowledge and Skills Required to Perform the Job:

• Knowledge of local, state and federal public health assistance programs and respective policies and regulations.
• Proficient in Microsoft applications and use of electronic health data systems including EPIC,  CalWin, CalHEERS. 
• At a minimum, have good computer/tablet literacy including internet navigation and research skill.
• Demonstrated ability to be culturally sensitive and respect diversity, work effectively with individuals of different cultures and socio-economic status; passion for service
• Self-starter and highly organized; ability to prioritize, and complete a large volume of work within strict time deadlines
• Provide prompt, efficient and responsive customer service 

Equipment Used:

• General office equipment including Computers, Laptops, phones, copy machines, fax machines, etc.

Working Conditions and Physical Requirements:

• May be required to lift up to 30 lbs., stand and walk frequently indoors and outdoors; setting-up/taking down Outreach equipment.
• Will be required to travel to other sites or other locations within San Diego County.
• Will be required to work some evenings and/or weekends