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Eligibility Specialist

Company: San Ysidro Health Center
Location: National City
Posted on: March 16, 2023

Job Description:

Position Summary:
Under the supervision of the Eligibility Department Supervisor, the Eligibility Specialist II will provide clinic in-reach, eligibility education, enrollment navigation and retention assistance aimed at support individuals/families in obtaining and retaining health care coverage.

Essential Functions of the Job:

  • Assists individuals and families in applying for and retaining health coverage by collecting required and accurate personal and demographic information; determining eligibility; assessing needs; providing accurate information regarding health coverage options; uploading/submitting verification documents and completing applications.
  • Complete and submit health coverage applications, presumptive eligibility applications, and gateway applications. Initiate and maintain proper follow-up with patient and government agency to ensure timely processing and completion of all mandated applications and accompanying documentation.
  • Monitors and initiates health coverage redetermination/renewal process for patients. Completes Medi-Cal Renewal Package, CCA Renewal Process, Reports all changes on active accounts, Medi-Cal Add-Ons, New Born Referrals.
  • Facilitates referral to SYH and community resources for assistance with other needs and intricate issues.
  • Maintains accurate and thorough records of all activities. Prepares statistical reports and patient/client correspondence. Submit monthly report by the 1st of every month.
  • Provides responsive, high quality service to patients, SYH employees, representative of County and outside agencies and members of the public by providing accurate, complete and up-to-date information in a courteous, efficient and timely manner.
  • Provide follow-up activities as needed to ensure families obtain and retain health coverage. A high focus will be on assisting high-acuity patients requiring more intensive assistance (i.e. senior, child or adult with disability) to ensure there is no lapse in coverage.
  • Conducts clinic in-reach and education activities, individually and in group, to SYH patients and community members at clinic locations and other community locations about SYH services and programs, public health assistance programs, health insurance options, voter information/registration and policy issues impacting the community. Submits clinic in-reach report by the 27th of each month.
  • Supports Eligibility Supervisor with on-site training for new staff when requested. Following proper procedures and training templates provided by Eligibility Supervisor. Additional Duties and Responsibilities:
    • Complies with all department, organization and government policies & procedures.
    • Attends meetings and trainings as required.
    • Provides CES coverage as needed.
    • Performs other related duties as assigned or requested. Job Requirements:

      Education Required: High School Diploma or GED equivalent required.

      Preferred: Bachelor Degree in a health or human service field.


      Reliable transportation

      Must pass the Covered California criminal background check and two exams
      1) Certified Enrollment Counselor (CEC) exam
      2) SYH Eligibility Competency Exam within the 90-day probationary period.

      Experience and Required Skills:
      • A minimum of one year of experience performing eligibility insurance or billing experience.
      • Related education may substitute for experience. Verbal and Written Skills to Perform the Job:
        • Must have excellent oral and written communication skills. Technical Knowledge and Skills to Perform the Job:
          • Knowledge of local, state and federal public health assistance programs and respective policies and regulations.
          • Proficient in Microsoft applications and use of electronic health data systems including NextGen, CalWin, CalHEERS.
          • At a minimum, have good computer/tablet literacy including internet navigation and research skill. About UsSan Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search ofmedical services for their families and community. Almost 50 years later, SanYsidro Health now provides innovative care to over 108,000 patients through avast and integrated network of 47 program sites across the county. San YsidroHealth could not serve our patients without the dedication of our passionateand hardworking employees. Apply today and become a part of our mission-driven team!San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to race, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws.

            Other details
            • Pay Type Hourly
            • Min Hiring Rate $17.31
            • Max Hiring Rate $25.96
              Apply Now

Keywords: San Ysidro Health Center, National City , Eligibility Specialist, Other , National City, California

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