Sr. Eligibility and Financial Screening Specialist (Special Populations)

Overview

Under general supervision, this role is responsible for coordination and day-to-day operations of eligibility determination, financial screening, application assistance and enrollment services for local, state, and federally funded healthcare programs and grant programs. This position provides support to the Eligibility and Financial Screening Supervisor and Manager in the administration of departmental functions, including leading work group activities, managing case referrals, conducting file reviews and ensuring compliance with regulatory standards and internal procedures. This role will also assist patients/clients with enrollment applications and is responsible for maintaining accurate client records. This position requires exceptional customer service skills, attention to detail, problem solving, and the ability to navigate complex systems and compliance standards.

This position is considered Hybrid, which means that individuals in this position may work both at an approved Offsite location and Onsite at a primary location or multiple locations based on Business Needs.

Responsibilities

Essential Duties 

• Lead work group activities as directed by program supervisor, including providing daily oversight and coordination for assigned eligibility work sites.
• Assist in implementing performance standards, delivering staff training, resolving staff inquiries and enforcing policies and procedures.
• Complete file reviews and performance reports for assigned staff.
• Support evaluation processes for activities performed by Eligibility Services staff, including site reviews, file assessments, interviews, outcome evaluations, and occasional assessments of contractor performance.
• Accurately apply the Eligibility Policies and Procedures to determine client eligibility and enroll eligible clients into the appropriate local and grant programs. Assist clients with submitting applications for state and federal health coverage programs.
• Coordinate and oversees MAP mail-in and electronic application processing to include assigning work responsibilities to staff and following-up to ensure applications are processed as per deadlines, resolving problems, answering staff questions and interpreting and enforcing policy and procedure.
• Compile data and generate reports to track key performance metrics, utilizing insights to improve client outreach and service delivery.
• Attend community events and represent the organization as needed, including evenings and weekends.
• Attend training and review all emails, newsletters and documents in order to stay current with changes in laws, regulations, and program eligibility requirements.
• Uphold the organization's values by consistently demonstrating professionalism in all actions, job performance, personal conduct, and communications.
• Perform other related duties as assigned.
• Disclaimer: The above job description is not intended to be exhaustive. Management reserves the right to revise the job duties or responsibilities at any time with or without notice.

Knowledge/Skills/Abilities:

• Strong planning, organizational, and time management skills, with the ability to prioritize tasks, manage competing deadlines, and maintain attention to detail.
• Excellent interpersonal and customer service skills.
• Bilingual (English/Spanish) highly preferred.
• Proficiency in data entry and use of EMR, Microsoft Office Suite, Excel, and Adobe Pro.
• Strong analytical and processing skills, with the ability to identify trends and improve performance outcomes.
• Knowledge of financial eligibility processes, regulatory standards, and specialty grants (Ryan White,
• Title V, PHC, Family Planning).
• Ability to effectively solve problems, resolve conflicts and apply critical thinking in a fast-paced environment.
• Ability to work effectively with diverse populations and adjust actions based on client needs.

Qualifications

MINIMUM EDUCATION: High School Diploma or equivalent (higher degree accepted) MINIMUM EXPERIENCE:• 4 years Experience working in health care, government, non-profit, or a customer service industry.

REQUIRED LICENSES AND CERTIFICATIONS:

• ACA Certification Within 6 Months Required AND
• Community Partner Program Certification Within 6 Months Required AND
• Data Security Certification Within 6 Months