Eligibility Clerk

Company Overview Equity Health is a federally funded community health center providing ambulatory primary health care services to low-income, medically underserved residents in the inner-city area of San Francisco. The Eligibility Worker, under general supervision of the Patient Accounts Manager, will make initial and continued eligibility determination of financial responsibilities for services provided under various funding categories and/or health center policies. The Eligibility Worker will also assist patients in identifying and enrolling in various benefits programs that may fully cover or defray costs associated with receiving health care services at Equity Health. Overview We are seeking a detail-oriented, friendly, and compassionate Eligibility Clerk to join our team. In this vital role, you will be responsible for verifying patient eligibility for various health programs, including Medicaid and other insurance plans. Your expertise in medical coding, healthcare regulations, and patient service will ensure accurate processing of patient information while supporting our mission to deliver equitable healthcare services. Duties and Responsibilities Determine eligibility for categorical financial aid programs as well as private insurance carriers, Medicare, and Medi-Cal. Conduct periodic review of eligibility as required by the individual program; Compile and maintain records relating to eligibility of clients. Register new clients in the clinic's Practice Management System for medical, dental and behavioral health services and update patient's registration records as necessary. Understand and educate clients on Sliding Fee Scale, and apply Sliding Discount Fee Scale to all patients in accordance to Equity Health's current Policies and Procedures. Work with Carelink (Dept of Public Health Practice Management System) to obtain B numbers for new patients.

Assist in revenue collection by:

collecting patient co-pays, nominal fees, and payments on outstanding account balances; processing applicable payments, registering patients in the Practice Management System, and submitting collections with payment report to Accounting Department by end of business day. Learn and implement special eligibility guidelines for programs that may supplement or replace other insurance coverage, such as: Family PACT (Planned Access Care and Treatment), Child Health Disability Program (CHDP), Presumptive Eligibility for Pregnant Women, Vaccines for Children Program (VFC), and Healthy San Francisco. Interview and assist patients in completion of any eligibility/enrollment applications and forms. Function as a Certified Application Assistor (CAA) for Healthy San Francisco enrollment, re-enrollment and modifying client applications . Manage interactions, both in person and by phone, with current and prospective patients, including set-up for services provided via Telehealth. As needed, call patients by phone to complete registration activities. Attend payor training events when required by Equity Health for registration of medical/behavior health services as well as certification of special programs. Follow Equity Health protocols and regulatory requirements regarding minor consent and treatment laws. Comply with all HIPAA regulations and Equity Health operational standards. Perform other duties as assigned and required. Experience High School diploma/GED required. Bachelor's degree in public health or social service-related field preferred. Experience providing in-person customer service in a healthcare setting. Non-profit, community healthcare experience with a Federally Qualified Health Center (FQHC) preferred. Familiarity with or understanding of Electronic Health Records (EHR) and the ability to gain proficient skills with the organizational EHR software programs (EPIC). Proficiency with Microsoft Office (Teams, Word, Excel, and Outlook). Bilingual in Spanish, Arabic, Cantonese, Mandarin, Vietnamese, Tagalog, or Nepali preferred. Skills Ability to relate sensitively to a multi-ethnic, culturally and socio-economically diverse clientele Ability to represent the organization in a positive and professional manner; strong attention to detail, work effectively under pressure, and prioritize multiple projects Exceptional communication, organizational, and interpersonal skills; work independently with minimal supervision Ability to work in a multi-disciplinary team environment; maintain good rapport and cooperative working relationships with Medical Providers, Department Managers, and staff Comfortable requesting and collecting payments for services from patients Ability to evaluate data and determine eligibility under various funding programs Strong problem-solving and decision-making abilities Adherence to Company policies and procedures; maintain consistent attendance and punctuality Absolute integrity and use of good judgment in handling confidential duties, tasks, and information Ability to keep and maintain accurate and legible treatment information and patient records Foster a culture of equity, inclusion, accountability, and innovation throughout the organization Physical and Environmental Working Conditions Work is normally performed in a typical office or clinic environment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

Physical:

Occasionally required to carry/lift/push/pull/move up to 30lbs. Frequently required to perform moderately difficult manipulative tasks such as typing, writing, etc. Must be able to stand and sit for extended periods. Requires the ability to reach with hands and arms and occasionally climb stairs. Requires sitting operating a computer keyboard, telephone, and other equipment for extended periods of time. Occasional travel to other Equity Health clinical sites may be required.

Sensory:

Frequently required to read documents, written reports, and signage. Must be able to distinguish normal sounds with some background noise, as in answering the phone, interacting with staff etc.

Environmental Conditions:

Frequent exposure to varied office (medical clinic, office) environments. Occasional exposure to dust and loud noises.

Equipment:

Frequently required to use a computer, phone, copy machine, fax machine, and other office equipment. This is not an exhaustive list of all responsibilities, skill, duties, requirements, or working conditions associated with this job. While intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that different tasks be performed when circumstances change. This job description replaces all previous job descriptions for this position.

Pay:

$22.05 - $29.55 per hour

Benefits:

403(b) Dental insurance Employee assistance program Health insurance Life insurance Paid sick time Paid time off Vision insurance

Work Location:

In person