Patient Eligibility Specialist

Description

 For more than 50 years, First Choice Community Healthcare has provided access to high quality primary medical, dental, and behavioral healthcare to the underserved populations of the Mid-Rio Grande Valley of central New Mexico. Today, we operate seven (7) Community Health Centers and one (1) school-based clinic. We are currently recruiting for a Community Health Worker to join our team and assist in fulfilling our organizations mission, which is to improve the health, life skills and wellbeing of all members of the communities we serve. Our health centers maintain an open-door policy, providing treatment regardless of an individual’s income or insurance coverage. As a non-profit organization, First Choice is a vital community resource in Central New Mexico. Not only does our organization provide the highest quality, comprehensive medical services, but we also address our patients’ emotional, social, and cultural needs. 

In addition to serving a community-centered organization we offer an excellent benefits package to include: 

Benefits Offered

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Flexible Spending Account
• Employee Assistance Program
• Aflac
• Life and AD&D Insurance
• Voluntary Life Insurance
• Identity Theft
• Retirement Savings -403(b)
• 10-20 days per service year (based on length of service)
• Sick Leave 64 hours per year (unused rolls over each year into Long Term Sick Leave)
• Long Term Sick Leave 40 hours per year 
• 10 Paid holidays per year
• 40 hours of Educational Leave per year for full time employees
• $700 per year for tuition reimbursement

A. Position Summary

Under the close supervision of the Outreach and Enrollment Program Manager or Health Center Manager, as applicable, the eligibility specialist works with patients and the public to determine eligibility for various healthcare funding programs, in a manner that is supportive and responsive.

B. Essential Duties and Responsibilities

Patient Outreach/Eligibility:

1. Provide accurate and impartial information to patients and the general public about health insurance coverage available to them and their families under the Affordable Care Act.
2. Conduct outreach and education activities in clinics and in community settings and door-to-door (as appropriate) on weekdays, weekends and evenings, as scheduled, to meet community needs.
3. Explain and assist existing patients and the general public with eligibility determination and application for various healthcare financial assistance and/or insurance programs, including all forms of Medicaid, Medicare, UNM Care, NM Health Insurance Exchange plans; Title X, BCC, CRC, Title V, and sliding fee discounts.
4. Verify insurance eligibility for Medicaid, Medicare, and third party payors, ensuring that all documentation has been accepted by HSD or other agencies.
5. Update patient records in the practice management system including income and insurance information.
6. Provide information to patients and the general public concerning functions of FCCH, ensuring customer satisfaction and the highest level of customer service.
7. Ensure that monthly quotas for enrollment are met and documented for grant reporting.
8. Answer the telephone and connect callers to the appropriate offices or individual staff, as necessary. Refer callers to other agencies when FCCH cannot meet needs.
9. Schedule appointments over the telephone and in person using the practice management system and other software as needed.
10. Other Duties, As Assigned.

Requirements

C. MINIMUM EDUCATION AND EXPERIENCE

1. High School graduate or GED certificate
2. At least two years related experience and/or training is required.
3. Bi-lingual English/Spanish is preferred.

D. LICENSES/CERTIFICATIONS REQUIRED

Obtain within first 6 months of hire/maintain a Presumptive Eligibility Determiner Number.

E. KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED

1. Comfort working with people one on one and in giving group presentations
2. Proficiency using the Internet and various software programs and computers
3. Proficiency using a laptop, wireless card, mobile scanners and cell phones
4. Good interpersonal communication skills and ability to establish a sense of trust while also maintaining professional relationship
5. Basic knowledge of health insurance and the health delivery systems
6. Ability to recognize and address barriers including cultural and language differences
7. Ability to summarize and explain complex information in different ways to meet diffe