Eligibility Specialist

The Eligibility Specialist (ES) will be responsible for interviewing and reviewing applications for PHC program and ensures that applicants meet eligibility requirements for Federally Qualified Health Care center.  Programs include Medicaid and local Indigent Programs and various social service programs, and services as eligible and defined by FQHC criteria.  Specialists assist those who are eligible through the application process.   This specialist reviews the application filled out by the potential recipient and determines whether or not there are any deficiencies. The specialist then meets with client, where the application is processed and filed. 

Conditions

• Acting as first contact for individuals seeking public assistance
• Interviewing applicants to obtain and verify information needed to determine initial and/or ongoing eligibility for assistance.
• Learning state and federal program regulations and specific county practices through training.
• Determining program eligibility in accordance with current regulations. 
• Researching questionable information provided by an applicant.
• Establishing and maintaining multiple case files through regular updating and review.        Documenting all communications. 
•  As part of the health center team the Eligibility Specialist prepares and submits required eligibility information for all patients.

Essential Functions

• Responsible for preparing all eligibility information for scheduled clinic appointment ahead of the appointed time. 
• Acts as advocate between county and patients. 
• Assists patients with referrals to Medicaid and other programs. 
• Works with front desk staff to ensure that all scheduled and non-scheduled patients are checked for eligibility and that all information is entered accurately and thoroughly. 
• Assists patients in identifying and enrolling in new state and/or county programs. 
• Keeps appropriate statistical records. 
• Attends all meetings that apply to the eligibility process and shares the information with appropriate clinic personnel. These meetings are typically off-site and may require the use of personal vehicle or other transit. 
• Follows up on incomplete applications within 30 days.  
• Performs other duties and projects as assigned. 

• If bilingual, translates in Spanish between non-Spanish speaking staff and Spanish speaking patients as requested.

Qualifications

·    Strong organizational skills and ability to work effectively under pressure in a positive, 

      friendly manner. 

·    Excellent verbal and written communication skills. Must be able to communicate at all

       levels. 

·    Patient and compassionate when interacting with patients and staff.

·    Ability to work independently and as a team player with staff and volunteers. 

·    Work in a team-oriented environment with a number of professionals with different work

       styles and support needs.

·    Excellent interpersonal, verbal, and written skills and ability to effectively work with

      people from diverse backgrounds and be culturally sensitive.

 ·    Ability to see how one’s work intersects with that of other departments and Clinic of Genesis 

       PrimeCare. 

·    Be creative and mature with a “can do”, proactive attitude and an ability to continuously 

      “scan” the environment, identifying and taking advantage of opportunities for improvement. 

Job Requirements

•      High school diploma or GED. 

        •     Two years’ experience in a community health care environment or primary care setting. 

       •      Knowledge of state Medicaid Programs and procedures. 

       •      Proficient in Microsoft office, tables, and flyers