Job description
Position: Eligibility Specialist
Department: Enrollment & Eligibility
Reports to: Enrollment & Eligibility Program Manager
Exempt: [ ] Yes [ X ] No
Supervises: N/A
Schedule: Full Time
Hours: Regular business hours; flexibility necessary to accommodate patient care needs and deadlines
Job Summary:
The Eligibility Specialist is responsible for determining slide eligibility for the Medical and Dental Centers, and for the Pharmacy discount program. This person is expected to have a working knowledge of the health insurance marketplace and Medicaid to help Center patients with enrollment in these programs.
Essential Job Duties and Functions:
- Counsel patients or responsible parties by telephone, mail, or face-to-face to advise them of BRMC’s sliding fee program, guidelines, the application process and required documentation.
- Process sliding fee initial and renewal applications upon arrival. Notify applicants of approval by sending approval letters which include attached membership cards detailing slide level and effective dates. Send denial letters as appropriate.
- Routinely review pending applications for completeness and communicate with patients concerning missing information.
- Enter Sliding Fee determination in eCW software according to procedures. Maintain accurate patient account data.
- Obtain Certified Application Counselor (CAC) status in order to assist patients and other consumers with Marketplace and Medicaid applications. Work with other CACs as needed to meet the needs of BRMC patients and other members of the community.
- Manage the Vision Assistance Program as it is available through VSP Vision Coupon/Vouchers, and/or BRMC’s Vision Fund.
- Maintain strict confidentiality as outlined by HIPPA Regulations.
- Other duties as assigned.
Working Conditions:
- Work in excess of 8 hrs./day or 40 hrs./ week to meet the Center’s needs and accomplish the duties of this position.
- Comply with and set example of compliance with BRMC’s policies/procedures/practices; comply with legal requirements for non-profit organizations.
- Perform and complete duties under stress and demands from different sources, and meeting strict deadlines.
- Tolerate prolonged computer related exposure. Able to sit or stand at a workstation for long periods of time.
- May be exposed to hostile or emotional clients, family members, and staff, as well as disturbing or sensitive information
- May be exposed to infectious diseases and medical waste.
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