Job Description

JOB PURPOSE: The Eligibility Specialist (Elk Ridge) is responsible for performing administrative duties and processing which include the determination of eligibility for services and application assistor in support of Elk Ridge Community Health services and its varied operations. The incumbent in this position will possess and demonstrate an advanced and comprehensive understanding of community, government, and private social services/agencies and programs; serves as an informational resource to clients and staff members. This includes eligibility requirements and procedures to effectively support the recruitment, registration, enrollment, and retention of consumers to the ACA Marketplace, AHCCCS, or discount programs; as well as referrals to social services or agencies.

An Eligibility Specialist (Elk Ridge) works with intermittent supervision and review, and any work problems involving departures from standard policies, interpretations, or procedures are reviewed with the supervisor, or applicable agency representative for resolution.

The primary goal of the Elk Ridge Community Health Eligibility Specialist (Elk Ridge) is to support Elk Ridge’s Mission of providing comprehensive, quality health care that is affordable and accessible to all who may have healthcare needs, by successfully performing the primary essential functions.

The following functions and responsibilities will contribute to Elk Ridge Community Health to achieve its KEY RESULTS:
1. World Class Experience for staff and patients
2. Healthier patients and employees
3. Positive Financial Result

Job Functions:
• Performs all assigned tasks, responsibilities, and assignments supporting departmental operations within established periods; meeting established rates of performance for the quality and quantity of work for the position; and demonstrating the highest levels of professionalism, quality, efficiency, and accuracy in the employee’s job performance that exhibits the highest standards of excellence.
• Understands and complies with all organizational Code of Conduct standards, Policies and Procedures, and Service Excellence requirements with all consumers, patients, visitors, employees, and internal/external clients or representatives.
• Maintains at all times employee and/or patient confidentiality by controlling the environment and information being disclosed to authorized individuals ensuring compliance with all HIPAA and corporate compliance standards, as well as accepted human resources confidentiality standards.
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• Gains and maintains a comprehensive and advanced knowledge, skills, and expertise on governmental and private healthcare programs, such as:
• Affordable Care Act, Healthy Arizona Plus, Sliding Fee Scale, etc.
• Performs ongoing investigative research in order to provide informational summaries and training on governmental and private healthcare programs.
• Serves as trainer and mentor to new and existing staff members on regulatory changes.
• Facilitates annual refresher or recertification training on the Affordable Care Act and other governmental or private healthcare programs.
• Participates in the review and development process of department operational policies and procedures.
• Provides recommendations on operational functions and process improvement or enhancement.
• Fulfills and performs all of the functions, duties, and responsibilities of an Eligibility Assistant.
• Provides timely and accurate scheduled or ad hoc reporting to internal/external departments or representatives, such as:
• Performs client eligibility status look up
• Provides system generated reports
• Performs data collection on outreach and operational activity
• Gains and maintains the knowledge, understanding, and skills to complete assigned administrative and clerical duties, tasks, and assignments working with program operating systems, programs, and/or business software, such as:
• Gains and maintains all training requirements and certifications necessary for eligibility and enrollment processing; and to serve as a Certified Application Counselor for the Affordable Care Act;
• Supports and assists consumers with public access and enrollment to HEAPlus and ACA Marketplace applications utilizing web based systems and software.
• Generates and distributes reports, summary information, and correspondence for the program for internal/external clients or representatives; as well as assisting with data entry of information and content into program systems, software, or spreadsheets for effective operational use and reporting.
• Supports and assists consumers by providing explanations, enrollment assistance, and information on eligibility options and requirements for programs such as: Medicaid (AHCCCS), ACA Marketplace.
• Demonstrates an exceptional level of customer service; answering and responding to all incoming calls, emails, and inquiries in a timely and effective manner; responding to requests for support providing information and solutions in response to inquiries; resolving technical inquiries or complaints.
• Communicates effectively through written, verbal, and interpersonal skills as applied when interacting with employees, internal/external clients or representatives, patients, or visitors, successfully conveying and exchanging information in a positive manner.
• As a team player demonstrates self-initiative by being aware of the work environment in order to assist co-workers and others while maintaining and enhancing a respectful and positive attitude in the work environment. Serving at all times as a positive and effective employee.
• Participates in a learning environment by being willing to teach other employees, providing new skills and knowledge that will enhance and improve the quality of service provided to consumers, as well as all internal/external clients or representatives.
• Serve as a contact point and liaison to internal departments and staff for problem-solving and in-service training related to eligibility services.
• Facilitates internal and external informational presentations to community groups or individuals on Affordable Care Act, AHCCCS, and other eligibility services.
• Performs public speaking on eligibility services to large and small groups in informal or formal settings;
• Creates presentations and materials that will meet the Center for Medicare/Medicaid Systems (CMS) guidelines and approval.
• Supports El Rio Health by participating in community events that promote good health and which contribute to a broader awareness and understanding of the governmental and private healthcare programs or services available to the community.
• Completes administrative processing of operational activity into program systems or spreadsheets to support effective and timely tracking, reporting, and invoicing of application completion and production.
• Gains and maintains proficient skill with all organizational or agency operating systems and programs by adapting to changing requirements and successfully learning and demonstrating new skills in response to system and program improvements or upgrades.

Joint Commission Responsibilities:
• Maintains a clean, safe, and hygienic work environment in compliance with all Policies and Procedures including but not limited to work areas, workstations, examination rooms, hand washing, infection prevention and control etc. for this position.
• Demonstrates an understanding of and proficiency with the application of all compliance and reporting requirements respective to Joint Commission Certification (JCC) standards.

Other Duties and Responsibilities:
• In support of the Mission and Vision of Elk Ridge Community Health, will at all times represent themselves as a professional role model of Elk Ridge Community Health serving as a positive informational source for members of the community.
• Supports Elk Ridge Community Health by participating in community events which promote good health, and which contribute to a broader awareness and understanding of Elk Ridge Community Health and the many services provided to the community.
• Participates in all appropriate health care activities related to Elk Ridge Community Health on a local, state, and national level to maintain and enhance Elk Ridge’s image with health agencies, professional associations, and the general public.
• Ensures and supports the cost-effective use of materials, supplies, and equipment by limiting waste of all organizational supplies and resources.
• In accordance with policies and procedures ensures that documentation of hours worked is completed accurately, as well as signed-off/approved in a timely manner.
• Employees must maintain their skills proficiency with Elk Ridge Community Health operating systems and/or software programs by adapting to changing requirements and successfully learning and demonstrating new skills in response to software, system, and program improvements or upgrades.
• Performs other duties as assigned.

Qualifications:

Minimum Qualifications Details
High School Diploma Or General Education Diploma (G.E.D.)
3 years
experience working as an Eligibility Assistant, Outreach Worker, or Certified Application Counselor for the Affordable Care Act.

Upon employment: gains and maintains certification and licensing as a Certified Application Counselor for the Affordable Care Act.
Fingerprint Clearance Card
Level I fingerprint clearance card: current valid and in good standing or have applied for it within seven working days after beginning employment

If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

Preferred Qualifications Experience Details
Bilingual (English/Spanish) with the ability to speak, read and write in both languages.

Transportation:
• Employees in this position are required to have reliable transportation that can meet any operational reassignments of the organization during the workday. If an employee is driving during work hours, the employee is required to possess a valid driver’s license and must comply with Arizona vehicle insurance requirements.

Core Competencies:
• Organization
• Time Management
• Teamwork
• Compassionate Communication
• Cultural Competence
• Honor Patient Privacy
• Service Recovery

Supervisory Duties:
• None

Skills and Abilities:
• Effective customer-facing and presentation skills.
• Interact diplomatically and positively with patients and the public in a continuous public contact setting.
• Ability to respond effectively in writing and verbally to internal and external customers.
• Write grammatically correct routing business correspondence such as brief transmittal memoranda
• Proficient with MS Office, including Word, Excel, Power Point, Outlook, and the internet.
• Ability to apply concepts such as fractions. Percentages, ratios, and proportions to practical situations.
• Ability to multi-task and maintain a professional composure in stressful situations.
• Excellent organizational and time-management skills.
• Ability to interact with persons of various social, cultural, economic and educational backgrounds for the purpose of providing exceptional guidance and customer service.

Workforce Environment/Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical Demand N/A Rarely Occasionally Frequently Constantly
Seeing X
Sitting X
Standing X
Talking X
Walking X

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Working Conditions N/A Rarely Occasionally Frequently Constantly
Vision Strain X
Weather X
Temperature X
Muscular Strain X

Additional Information:
This job description has been reviewed to ensure that the minimum functions and basic duties have been included to successfully perform the duties, tasks, assignments, and responsibilities of this position. Additional functions, duties, tasks, or requirements may be assigned by leaders as deemed appropriate to meet organizational operations. The job functions and responsibilities align with Elk Ridge Community Health’s Cultural Beliefs:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Elk Ridge Community Health does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, age 40 and over, disability, genetic information, military status, ancestry, marital status, familial status, or any other status protected by law or regulation.

It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.

All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.

Elk Ridge Community Health is a Non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards.