Eligibility Specialist

Business Operations Full Time

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Full-Time
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COMPANY OVERVIEW: Catholic Charities is the social ministry outreach of the Archdiocese of Washington. We believe in strengthening the lives of all in need by giving help that empowers and hope that lasts. Catholic Charities works to create a world in which every person is cherished, regardless of individual limitations, and strengthened in the use of personal gifts in order to reach his or her full potential as a valued member of the community. We are looking for exceptional people who share our vision and values.

Inspiring Hope. Building Futures.

JOB SUMMARY: The Eligibility Specialist of the Catholic Charities Health Care Network (CCHCN) reviews and approves specialty eligibility applications and provides feedback to all primary care clinic staff regarding the eligibility screening and approval process.

ESSENTIAL DUTIES and RESPONSIBILITIES:
Act as the primary contact for the program’s eligibility process with clinic staff.
Approve applications and maintain individual program eligibility in the system. On the first day of each month, reports on the number of eligibilities screened, approved or denied.
Review specialty eligibility applications in Community Health Link Cares (CHLC) to ensure completeness and clarity of information submitted.
Communicate documentation discrepancies and follow up with patients to submit appropriate proof of documents within 10 business days (two weeks).
Maintain confidential patients’ records for the program.
Respond to incoming calls, provide information about eligibility process, and refer any eligibility inquiries accordingly.
Act as an advocate for patients needing additional information, support, or services.
Discuss any problems related to the eligibility process with the Program Manager or Nurse Case Manager to resolve problems.
Teach CHL class every 1st month of the quarter.
Ensure Clinics and patients understand the range of services offered i.e., sliding fee scale, Patient Agreement and Privacy Rights.
Maintain and promote a positive image of CCHCN to existing and potential clients.
Participate in Quality Improvement projects, collect data and provide suggestions. Generate ideas for improvement and participate in their testing and implementation when required. Incorporate the resulting guidelines from the quality improvement initiatives and process into job duties.
Update primary care clinic information data.

EDUCATION and EXPERIENCE:
High school diploma or associate degree.
One-year experience working with low-income, uninsured, and ethnically diverse populations preferably in health care setting/organization.

SKILLS and COMPETENCIES:
Bilingual English/Spanish.
Ability to communicate effectively verbally and in writing.
Ability to communicate and work effectively with a broad range of collaborators including clients, clinicians, hospitals and others.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)

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