Medi-Cal Eligibilityspecialist

Job Summary: The Medi-Cal Eligibility Specialist assesses, advises, informs, and assists the uninsured and the underinsured patients in determining eligibility and liability for Inpatient, Outpatient, Emergency Room, Observation admission and services.

Interviews patients or their families to establish Hospital Presumptive Eligibility, Medi-Cal Fee for Service, SOC, Cash payment and/or Charity linkage in accordance with all federal, state and local laws, rules and regulations that apply to activities pursuant to these program. Initiates and follows Medi-Cal and other County, State or Federal applications to completion for approval or denial. Determines and collects patient liability for all urgent and emergent, international and cash admissions.

Assists patients with appeal processes when applications are denied. Patient liaison between outside County Eligibility worker and patient. Performs other duties as assigned.

Education and Experience: High School Diploma or GED required. Minimum one year of experience required in hospital-based registration, Medi-Cal, Customer Service and California Children's Services required with emphasis on Federal, State, and County eligibility regulations and requirements preferred, five years preferred.

Knowledge and Skills: Able to keyboard 35 wpm.

Able to read, write legibly; speak in English with professional quality; use computer, printer, and software programs necessary to the position (e.g., Word, Excel, Outlook, PowerPoint, Availity, Medi-Cal, HPE, LLEAP). Operate/troubleshoot basic office equipment required for the position. Able to relate and communicate positively, effectively, and professionally with others; work calmly and respond courteously when under pressure; collaborate and accept direction. Able to communicate effectively in English in person, in writing, and on the telephone; think critically; manage multiple assignments effectively; organize and prioritize workload; work well under pressure; problem solve; recall information with accuracy; pay close attention to detail; work independently with minimal supervision. Able to distinguish colors as necessary; hear sufficiently for general conversation in person and on the telephone, and identify and distinguish various sounds associated with the workplace; see adequately to read computer screens, and written documents necessary to the position.

Licensures and Certifications: Valid Driver's License required at time of hire. Certification from the Department of Social Services in Medi-Cal eligibility determination preferred.