Medical Eligibility Supervisor (CC26143 - NIC)

The Medical Eligibility Supervisor is responsible for overseeing Qualified Health Plan (QHP), Medicaid, CHIP and other related programs. Supervises Medical Eligibility Specialists (MES) and oversees health plan enrollment activities and customer service regarding billing and patient account inquiries. Manages medical health plan enrollment services to all CommuniCare patients seeking assistance in making informed decisions on the selection of a health plan. 

 

DUTIES AND RESPONSIBILITIES:

1. Supervises Medical Eligibility Specialists, including work allocation, staffing coverage and problem resolution; monitor staffs time and attendance; evaluates performance and makes recommendations for personnel actions; ensure staffs achieve peak productivity and performance.  Ensures training and adherence of staff to policies, procedures, and standards; coordinates in-service training, continuing education, orientation, competency reviews, and other related training functions.   

2. Performs new patient registration, updates patient information, data entry of demographics, and any other required information. Verifies third party benefit coverage to include co-pays, deductibles and co-insurance. Ensures accurate activations of plans and programs and records special notations in patient account software; assists patient with registration. Prepares for next day clinic session to include reviewing and confirming appointments, noting alerts for payments and balances. 

3. Oversees enrollment activities of QHP, Medicaid and CHIP health insurance and other related programs. Conducts eligibility screening on patients for various programs available through the Center; accurately places clients on appropriate programs based on funding source requirements. Performs follow-up eligibility process to include contacting patient for additional information and contacting the funding source for eligibility status. 

4. Maintains knowledge and expertise in eligibility, enrollment, and program specifications of the Federal Marketplace and other health coverage programs such as Medicaid and CHIP. Complies with departmental policies and funding source requirements; maintains current level knowledge of updates in funding source regulations.  

5. Ensures the protection and security of a consumer’s personal, confidential and identifiable information in a professional and responsible manner, according to the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA). 

6. Processes credit card payments, ensures payments are applied correctly in patient accounts. Completes end-of-day reconciliation report; ensures that credit card payments reconcile with practice management report.  

7. Assists with training support staff on insurance verification, entering demographics, program eligibility requirements, payment processing, and other related duties.

8. Provides exceptional internal and external customer service. Communicates with clients, support staff and third party payors to address billing questions and concerns. Makes payment plan arrangements with patients when appropriate.

9. Performs other related duties as assigned. 

 

JOB QUALIFICATIONS:

High school diploma or equivalent

Two (2) years’ experience in billing and collecting of third-party health insurance

Significant expertise in billing and eligibility requirements for Medicare and Medicaid

Two (2) years’ experience supervising and training staff in a healthcare setting

Extensive knowledge of ICD-10-CM and CPT codes and medical terminology

Advanced knowledge of computerized billing systems

Proven proficiency in Excel spreadsheets, Microsoft Word, Outlook 

EPM, EHR, CPC, RHIT or equivalent certification preferred 

Must complete up to 30 hours of training to obtain consumer assistance certification within 12 months and recertify on an annual basis.  

Bilingual in English and Spanish preferred

Scheduled hours and/or work locations are subject to change

 

PHYSICAL ACTIVITIES AND REQUIREMENTS:

Finger Dexterity: Using fingers to make small movements such as typing or picking up small objects.

Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.

Hearing: Able to hear average or normal conversations and receive ordinary information.

Repetitive Motions: Frequently and regularly using the wrists, hands, and fingers.

Visual: Average, ordinary, visual acuity necessary to prepare or inspect documents or other materials.

Physical: Limited physical effort required; May lift folders, files, papers, audio/video equipment, and other such items weighing up to approximately 25 lbs.