Job Summary:
The Eligibility Specialist assist with the application process and referrals to all State and Federally funded assistance programs, including but not limited to Medicare, Medicaid, Disability and Charity programs. The Eligibility Specialist not only acts as an advocate for the customer, but also serves as a liaison between colleagues, clients, and State/Government agencies in a collaborative effort to facilitate eligibility coverage for current and future medical expenses.
Essential Duties & Responsibilities:
- Handle high volume of inbound/outbound calls for customers that need to be screened financially and medically for financial assistance.
- Perform face to face interviews with customers in a centralized company’s office, client site or home environment to determine eligibility for financial assistance.
- Use the client eligibility screening tool to determine customers eligibility for all State and Federally funded programs that will provide financial assistance to resolve current or future hospital bills.
- Collect and process upfront deposits or set up payment arrangements, as required.
- Conduct the appropriate application support based upon state or federal regulations. Facilitates the application process or directs the customer to the appropriate next step.
- Provide instruction or work directly with the customer or their appointment of representative to complete the appropriate application and acquire all necessary releases, signatures and supporting documents.
- Submit the application and supporting documentation to the appropriate institution in accordance with company protocol.
- Act as an advocate for the customer, but also serves as a liaison to other colleagues, client hospital personnel, and government agency staff in a collaborative effort to establish eligibility coverage for future or incurred medical expenses.
- Provide superior customer service and maintains a professional image.
- Meet or exceed established productivity, quality, and revenue metric
Minimum Qualifications & Competencies:
- High school diploma or GED.
- At least six months of experience in a customer service role, interacting directly with customers either in-person or over the phone.
- Experience working in a role that requires prioritization of multiple critical priorities while ensuring quality and achievements of performance metrics.
- Demonstrated experience communicating effectively with a customer and simplifying complex information.
- Experience in a role that requires accessing multiple databases simultaneously or managing multiple open screens to gather information to discuss with a customer.
- Experience with customer interactions that require live, accurate documentation of the encounter.
- Ability to handle sensitive information and maintain HIPAA compliance.
- Demonstrated ability to navigate Internet Explorer and Microsoft Office.
- Maintain acceptable attendance and schedule requirements.
- Proven time management skills.
- Must be willing to work onsite in Ortigas, Pasig City
Preferred Requirements & Competencies:
- Six months of experience working within financial counseling in a Hospital, Physician office or home environment, including demonstrated success obtaining patient demographic and financial information, handling insurance verification and obtaining authorizations.
- Understand federal or state government agencies including Social Security, Medicaid or charity care, healthcare accounts receivable within the healthcare revenue cycle touching patient accounts.
- At least six months of experience working in a role with a high volume of either inbound or outbound calls through an automatic dialer
