Eligibility Clerk - Alameda Health System

SUMMARY: Under general supervision, the Eligibility Clerk (EC) provides a specialized clerical support service to the various hospital and clinic registration units and screens patients for possible eligibility for various financial programs. Specially trained to perform the patient registration and less complex enrollment of eligible patients into various financial assistance programs. The Eligibility Clerks may be required to work in a 24/7 unit and may be required to work in alternate locations as necessary. Program enrollment responsibilities include but are not necessarily limited to the following: County Medically Indigent Services Program (CMSP), Childhood Health and Disability Program (CHDP), Charity (AHS's Charity Program), Presumptive Eligibility (PE), and Cancer Detection Program (CDP). Performs related duties as required.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1. Advises patient/guarantor of financial obligations and collects and processes deposits, co-payments and pre-payments for services.

2. Assists with special projects and performs related clerical and administrative duties as required, such as filing, reception, or data entry.

3. Completes, submits forms and documents within the specified timelines required by the respective agencies.

4. Determines the less complex enrollment options for eligible patients into various financial assistance programs.

5. Informs and advises medical providers of patients' financial status and maintains open communication with Physicians and clinical staff to ensure timely notification of any health conditions or diagnosis that could qualify patients for programs to assist them with their healthcare costs.

6. Interprets laws and regulations of Federal, State and County programs and advises patients of eligibility requirements, as well as their rights and obligations in receiving financial services from these programs. Assists patients in completing applications and forms, as necessary, and reviews the same for accuracy and completion.

7. Keeps abreast of internal and external programs offered, including those offered through mandatory departmental training sessions.

8. Registers and interviews patients and their representatives; includes obtaining necessary identification, accurately filling out applications with demographic and financial information.

9. Reviews and follows all relevant policies, procedures, guidelines and laws.

10. Utilizes computer applications and on-line programs to research.


MINIMUM QUALIFICATIONS:

Education: High School diploma or equivalent.

Minimum Experience: Bilingual, where necessary.

Minimum Experience: Demonstrated use of PC systems and general navigation through application systems.

Minimum Experience: One-year working at AHS as Clerk II, Specialist Clerk, Medical Clerk, Lead Clerk, or other equal classification; one-year performing eligibility work in a medical or clinical environment preferred. (After hire: Successful completion of the Eligibility Academy/Training Programs and respective examination offered through AHS within timeframe determined by supervisor/designee.)

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