Enrollment & Eligibility Specialist I - Trillium Health NY

Purpose: Responsible

for the patient insurance verification process. Interpret and apply sliding fee

scale and ensure that documentation related to the sliding fee scale is

accurately and consistently captured in the electronic medical record. Enroll

eligible patients into Ryan White Part C/FQHC programs at intake and alerts

patients to recertify annually. Assess and enroll patient in other assistance

programs for which they qualify. Inform and advises on policies and procedures

related to uninsured patients. Ensure cross-departmental support and

collaboration.







Key

Job Responsibility Areas







1. Patient

Insurance Verification Process



2. Ryan White

Part C Enrollment and Recertification



3. Policies and

Procedures



4. Sliding Fee

Scale



5. Cross-Departmental

Support/Collaboration



6. Miscellaneous







Detail

of Key Job Responsibility Areas



1. Patient Insurance Verification Process



A. Perform

insurance verification checks at least three days prior to patient appointment

in order to maintain compliance with Ryan White legislation and associated

guidelines.



B. Ensure

“primary” and “secondary” valid insurance designations are accurately

represented in electronic health record



C. Contact

patient when insurance checks result in invalid status and establish strategy

for addressing gaps (referrals to services, possibly rescheduling patient until

insurance matters have been resolved, etc.)



D. Ensure

patient demographics are maintained with updated information.



E. Assess

patient for eligibility for Medicaid, Medicare, and private insurance available

through ACA marketplace and assist patients in applying for assistance.



F. Assist

patients in applying for insurance assistance during ACA open enrollment.



G. Populate

“know your coverage” scorecard and educate patient on information in scorecard.







2.

Ryan White Part C Enrollment and Recertification



A. Enroll

patients into Ryan White Part C program at intake, conduct 6 month and annual

recertification. At each recertification, determine the patient’s level of Ryan

White Sliding Fee Scale and Cap on Charges and educate patients about these

benefits.



B. Assess

patient for eligibility for Medicaid, Medicare, and private insurance available

through ACA marketplace and assist patients in applying for assistance.



C. Manage

enrollment paperwork, primary insurance, proof of residency, and proof of

income.



D. Monitor patient

progress toward Ryan White Cap on Charges and adjust a patient’s cap in

coordination with Billing and document it consistently in the electronic

medical record as needed.



E. Educate

patient on Ryan White program “benefits” and services.







3. Sliding Fee Scale



A. Interpret and

apply sliding fee scale for FQHC Sliding Fee Scale and the Ryan White Sliding

Fee Scale; ensure documentation related to sliding fee scale is accurately and

consistently captured in electronic medical record.



B. Responsible

for educating patients and prospective patients on sliding fee scales.







4.

Policies and Procedures



A. Follow

all established policies & processes related to uninsured patients.







5.

Cross-Departmental Support/Collaboration



A. Communicate directly with patients who submit billing

& reimbursement questions through the patient portal.



B. Collaborate

with Front Office Team to coordinate enrollment and eligibility follow-up as

needed.



F.

Conduct initial screen for Care Management services and link to Care Management

when a patient qualifies for services.



C. Collaborate

with Referral Specialist by reconciling “primary”/”secondary” insurance

designations and establishing a central repository for others to quickly

reference prior authorization requirements by payer C.



D. Collaborate with Referral Specialist on status of

communication to patient when periodic reassessments or other data is required,

therefore eliminating “mixed messages” and enhancing patient/client

satisfaction.







6. Miscellaneous



A. Requires

the ability and commitment to respect and support inclusiveness and diversity

including but not limited to individuals of different backgrounds, cultures,

races, ages, sexual orientations, gender identities or expressions,

experiences, opinions, etc.



B. Requires

individual demonstration of commitment to the One Trillium behaviors and

business impacts and modeling them in the organization.



C. Responsible

for maintaining confidentiality of all patient, client, employee, protected and

proprietary information.



D. Employees

are accountable for meeting the performance standards of their departments and

must participate as requested in compliance audits, process improvement and

quality improvement plans.



E. Other

duties as assigned.







Qualifications



Bachelor’s degree preferred.

At least three years’ of experience in human services/medically based setting

required. Must hold valid NYS certificate as Insurance Assister. Knowledge of sliding

fee scale. Knowledge of insurance and experience with prior authorizations

required.



Competencies



· Effective performing multiple tasks during workday.



· Proficiency in MS Office and computer/automated systems for data

purposes.



· Proficiency with electronic medical records systems.



· Excellent organization, communication and interpersonal skills

a must with the ability to communicate effectively verbally and in writing; and

utilize good listening skills.



· Ability to work effectively in a collaborative, team-based work

environment, including the ability to positively receive and give constructive

feedback.



· Ability to function autonomously as a worker and as a team member

on a multidisciplinary team



Physical

Requirements



While performing the duties of this job the employee is required

to stand, sit, walk, use hands to finger, handle, or feel; reach with hands and

arms, talk and hear. Occasionally the employee must stoop, bend and lift

or move up to 25 lbs. Specific vision abilities required include close

vision, distance vision, peripheral vision, depth perception and ability to adjust

focus.



In support of the Americans with

Disabilities Act, this job description lists only those responsibilities and

qualifications deemed essential to the position.