Eligibility Specialist

Job Title:  Eligibility Specialist                                                          FLSA: Non-Exempt              

Reports To:   Claims Support Supervisor                                         Status: Full-time       

Last Update: 8/22/2024                                                                   Next Review Date: 8/22/2026

Company Summary: Crossroads is an Arizona Department of Health Services licensed substance abuse treatment provider with proven expertise in serving men, women, and Veterans with Substance Use Disorder through the provision of high quality, successful, and affordable residential and outpatient recovery programs.

Due to federal contracts the following items are prohibited:  Medical/Recreational marijuana, current parole, or probation. 

Job Summary: The Eligibility Specialist ensures timely and accurate verification of benefits and eligibility for individuals admitted for services daily. The Eligibility Specialist also identifies appropriate funding sources for uninsured clients (i.e. Substance Abuse Grants). The Eligibility Specialist will gain a thorough knowledge of all client-funding sources – Medicaid, Medicare, private / commercial insurance, grants, etc. and be able to advise the best possible scenarios for each client.

Supervisory Responsibilities: 

·         None

Essential Functions:

·         Initiate Federal-Funding Enrollments and track and monitor all requests thru to completion.

·         Provides departmental support for claims projects or related eligibility projects.

·         Work with Claims Support Supervisor for any clients unable to obtain funding for services. 

·         Updates EMR system to validate insurance and monitor client eligibility throughout treatment.

·         Proper documentation in the EMR system. 

·         Perform other duties as needed.

Qualifications:

·         Provides superior customer service while maintaining professionalism. 

·         Current CPR/First Aid/Narcan training.

·         Current and annual negative TB Test.

·         Clean Motor Vehicle Record (MVR) check performed annually and upon hire, preferred.

·         Successfully pass a background check and an Arizona Department of Health Services Adult Protective Services check.

Knowledge, Skills, and Abilities:

·         Strong Computer/Microsoft Office/EMR skills.

·         Able to handle sensitive information and maintain HIPAA compliance.

·         Possess excellent analytical, judgment and problem-solving skills.

·         Excellent organizational, multi-tasking, detail-orientated and prioritization skills required.

·         Excellent communication skills both verbally and written. 

·         Must be able to work with management and cross-functional teams to support revenue cycle efforts.

·         Must be able to work independently and as a member of a team.

Education & Experience:

·         Minimum High School Diploma or GED is required, associate degree is preferred.

·         Minimum of 1 year experience working with Arizona Medicaid, Medicare, Private/Commercial Insurance, Insurance Verification and Authorizations preferred.

·         Minimum of 1 year working within Behavioral Health, Rehabilitation, or other related field preferred.

Work Environment:

·         Fast paced behavioral health setting.

·         Primarily indoors, however, some outdoor work may be requested.

Physical Demands:

·         While performing job duties, the employee is regularly required to sit and speak or hear. The employee is occasionally required to stand, walk, use hands to handle or feel, reach hands and arms, stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 50 pounds and seldom lift and/or move >100 pounds. Specific vision abilities required by this job include color vision, depth perception, and ability to adjust focus.

Shift Requirements: 

·         Days.

Travel:

·         Valid AZ Driver’s License. 

·         May include travel between sites and other locations.

·         Local and statewide travel when requested or required.

EEO:

·         Crossroads is committed to providing a workplace free from harassment and discrimination. We believe all applicants and employees should be treated equally without regard to an individual’s race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors.

ADA Acknowledgement:

·         To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions.

Benefits:

401(k) with matching of up to 3%

Company paid premiums for the full-time employee for Medical, Dental, Vision and Life Insurance

Supplemental Life Insurance and short-term disability

Paid time off

Tuition Reimbursement

If you require alternative methods of application or screening, you must approach the employer directly to request this.

This posting will remain open until filled and for a minimum of 7 days.