Certified Eligibility Specialist II (Alpine)

Position Summary:

The Certified Eligibility Specialist II will provide clinic in-reach, eligibility education, enrollment navigation, and retention assistance aimed at supporting individuals and families in obtaining and retaining health care coverage.

Essential Job Functions:

• 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 and renewal process for patients. Completes Medi-Cal Renewal Package and CCA Renewal Process. Reports all changes on active accounts, Medi-Cal Add-Ons, and Newborn 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, representatives 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. Outreach 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.

• 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 training courses as required.

• Provides CES coverage as needed.

• Performs other related duties as assigned or requested.

Job Requirements:

Education Required (Minimum level of education):

Required: High School Diploma or GED

equivalent

Preferred: Bachelor's degree in a health or human services field.

Certifications/Licenses Required:

• Must pass the Covered California criminal

background check

• Must pass two (2) exams: Certified Enrollment Counselor Exam (CES) and SYH Eligibility competency exam within 90-day probationary period

Experience Required (Minimum level of experience):

• A minimum of one year of experience performing insurance eligibility or billing experience. Related education may

substituted for experience.

Verbal and Written Skills Required to perform the Job:

• Must have excellent oral and written communication skills

• Required: Bilingual (English/Spanish)

Technical Knowledge and Skills Required 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 Epic, CalWin, CalHEERS.

• Good computer and tablet literacy, including internet navigation and research skills.

• Demonstrate ability to be culturally sensitive and respect diversity, work effectively with individuals of different cultures and socio-economic status; passion for service; self-starter and highly organized.

• Ability to meet strict deadline and provide prompt, efficient and responsive customer service.

Equipment Used:

Computers, Laptops, Phones, Copy/Fax machines and

other general office equipment.

Working Conditions and Physical Requirements:

• May be required to lift up to 30lbs.

• Stand and walk frequently indoors and outdoors; set-up/take down Outreach equipment.

• Will be required to travel to other sites or other locations within San Diego County.

• Will be required to work some evenings and/or weekends.

• Must have reliable transportation.

About Us San 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 of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and 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 $23.11

• Max Hiring Rate $30.48

• Travel Required Yes

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• 1620 Alpine Blvd, Alpine, CA 91901, USA