Eligibility Program Specialist

We are looking for a Eligibility Program Specialist

Payrate: $22.00 hourly

Required Skill Set

  • Data Entry Experience
  • Detailed
  • Organized
  • Good People skills
  • Experience with Electronic Health Records

Job Description

  • This position is responsible for essential functions of the Eligibility Department in order to conduct Determination of Intellectual Disability (DID) assessments. Duties include direct contact with clients, manage daily department flow, coordination with multiple departments, data collection, data entry, coordination with Patient Financial Services (PFS) organization of records, scheduling, pre-screeners, obtaining prior authorizations, electronic and postal mailing, filing and communication.

Essential Functions

  • A. Manages DID Referrals and Schedules DID Appointments.
  • 1. Admits individuals into Eligibility Department via Electronic Health Record (EHR).
  • 2. Schedules Determination of Intellectual Disability (DID) appointments primarily by phone.
  • 3. Schedule appts utilizing Language Line for non-English speakers other than Spanish.
  • 4. Enters appointment information onto assessors’ Outlook calendars.
  • 5. Receives Prior Authorization insurance information from PFS-IV and adds to Outlook appointment.
  • 6. Makes calls 1-3 days in advance of DID appointments to remind individuals of appointments, and to verify current address and telephone number.
  • 7. Reschedules appointments when needed.
  • 8. Writes letters to client or legal guardian informing them they have missed their appointment and need to (re)schedule when they cannot be reached by phone.
  • 9. Sends “10-Day” letters to nonresponsive individual of impending discharge from Eligibility services.
  • 10. Enters Provisional Diagnosis and ABL into EHR.
  • 11. Locates information needed by Assessment Specialists to complete DID report.
  • 12. Acquires external records through ROI for assessors to complete DID.
  • 13. Sends folders to chartroom to be scanned into electronic health record system, EHR.
  • 14. Scans Eligibility documents into I Drive as needed.
  • 15. Creates Eligibility Dept client folders for Assessment Specialists
  • 16. Mails DID report and associated documents to the individual/guardian.
  • 17. Provides Eligibility documents to referral sources.
  • 18. Discharges clients from Eligibility Dept.
  • 19. Manages Data and Statistics

Performance Requirements:

  • 1. Enters and updates DID status info into DID spreadsheets as the appointment progresses.
  • 2. Generates weekly and monthly count of DID appointments available, scheduled and kept.
  • 3. Enters Eligibility documents and additional records into EHR.

Collaborates with Other Departments

  • 1. Provides other departments requested Eligibility documents, e.g., DIDs, ICAPS, 8662, CARE forms.
  • 2. Receives notifications when ABLs need to be entered into EHR and enters them.
  • 3. Fulfills DS program managers’ requests for Eligibility department records.
  • 4. Searches I-drive, Paper vision, EHR, and chartroom to fulfill document request.
  • 5. Refers clients who inquire about services to appropriate department for services, such as ICARE.