Enrollment Specialist

Job Summary

The Enrollment Specialist is responsible for verifying and collecting accurate and timely insurance information for patients. Will interact with the patient via telephone and person to finalize and document information regarding insurance coverage. Additionally, will educate, inform and assist patients about their responsibilities including copays, coordination of benefits and the enrollment process. Works closely with Registration, Health Benefits and Patient Accounts to ensure all required information is gathered accordingly.

ESSENTIAL DUTIES AND RESPONSABILITIES include the following as well as other duties and responsibilities that may be assigned:

• Accurately performs all functions related to insurance eligibility by phone, verifying eligibility and providing information on next steps.
• Enter and/or update all insurance information collected into the practice management system in a timely manner and with a high degree of accuracy.
• Navigate through multiple systems to input and retrieve eligibility information, asses and notate eligibility information pertinent to patient appointments.
• Contact patients whose insurances are inactive with advance notice to gather insurance information.
• Provide information about health insurance and financial assistance program options including sliding fee scale.
• Verify effective date and benefit information including primary care provider site, co-pays, and outstanding balances.
• Work closely with the Registration and Health Benefits department to act upon and resolve any issues involving patients who are uninsured or underinsured.
• Address eligibility alerts, electronic actions and telephone encounters as corrections to patient accounts.
• Provide patients with courteous, friendly, fast and efficient services.
• Maintains current knowledge of Registration and Health Benefits processes and system changes.
• Act as an administrative resource to the health center when problems or questions with eligibility arise.
• Complete Navigator training and recertify annually.
• Attend and participate in trainings, webinars and conference calls to stay current on state changes pertaining to health insurance, as requested by your supervisor.
• Track, compile data and prepare reports on a monthly basis.
• Perform other duties as assigned.

Education/Experience

• High school diploma or equivalent, minimum of two years’ experience in a customer service related position, preferably in a health care setting.
• Knowledge of Health Care system and insurance eligibility is a preferred.
• Experience working with diverse communities and understanding of multi-cultural beliefs, practices and cultures is a plus.
• Possess strong commitment to the team, contribute expertise and follow leadership directives at appropriate times.
• Must be detail oriented and have the ability to multi-task.
• Data entry, computer and phone skills are required
• Must have the ability to remain calmand professional in a fast-paced environment.
• Bi-lingual in English and Spanish, Portuguese or Khmer preferred.

Other Elements:

Knowledge                Reimbursement and third party payer procedures and collection techniques Ability to accurately enter and review data. Ability to multitask. Knowledge of Microsoft and Outlook.

Judgment                  Demonstrates good judgment in reasoning when investigating and solving problems. Respect the confidentiality of patient information in compliance with the HIPAA and other applicable regulations.

Action                         The ability to prioritize the assignments and become an insurance navigator within the 60 days of hiring.

Accountability           Ability to meet deadline and work product. Ability to perform assigned duties with minimal direction and supervision in a timely manner.  Ability and flexibility to work in-office or remotely.

Interrelationships     Effective interaction with external and internal representative affecting the medical billing and patient revenue activity.  Must communicate clearly in consistent manner and work towards resolution of problems with immediate staff and other managers.

Environment             The work environment are general business office working conditions.

Physical Effort          The physical demands described here are representative of those

that must be met by an Employee to successfully perform the essential functions of this job. Requires minimal physical efforts and constant use of computer, telephone and fine printed information.  While performing the duties of this job, the employee is frequently required to stand, walk, sit, and use hands to finger, handle or feel.  The employee is occasionally required to reach with hands and arms, climb or balance, and talk or hear.  The employee must frequently lift and/or move up to 25 pounds.

Occupational Risks Regular volume of work and deadlines impose stress on routine basis.  Frequent interruptions. The noise level in work environment is usually low to moderate.

Character of

Supervision               This position does not require supervision.