Eligibility Specialist - Team Lead
Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).
The Lead Eligibility Specialist works as an advocate for patients and maintains a level of passion in helping support their communities. The Lead Eligibility Specialist assists with the application process and referrals to all State and Federally funded assistance programs, including but not limited to Federal programs: Social Security Retirement, Survivors, Disability, SSI, Medicare part D, State programs: Medicare savings program: QMB, SLMB, QI1, QDWI and Medicaid for aged, blind, disabled, Veteran's assistance, Community Based waiver programs: Hospice, Respite, Personal Home Care, Medical Supplies, Transportation, Food Stamps, Pharmacy assistance, Housing/living assistance. as well as re-enrollment of programs re-referred to Savista. The Community Engagement Specialist will also communicate and work with multiple stakeholders including but not limited to: Client staff, patients, and/or patient family or appointed representatives and government agencies.
Essential Duties & Responsibilities
- Act as an advocate for the patient, but also serves as a liaison to other colleagues, client clinic personnel, and government agency staff in a collaborative effort to establish eligibility coverage to support social determinants of health.
- Handle high volume of inbound/outbound calls for patients that need to be screened financially and medically for applicable benefits.
- Leverage different modalities of contact through appointments, dialer, text, email, letters, manual calls, clinic visits, virtual conferences, and field visits to perform screening with patients while educating them on their eligibility.
- Utilize screening tools to determine patients’ eligibility for all State and Federally funded programs that will provide medical/financial assistance to the patient.
- Provide instructions and work directly with the patient or their appointed representative to complete the appropriate application, set up/attend agency appointments, and acquire all necessary releases, signatures, and supporting documents.
- Facilitates the application process and directs the patient to the next steps to obtain program determination.
- Assisting the patient to resolve discrepancies with the State/Federal/external agencies.
- Submit the patient’s application and supporting documentation to the appropriate institution in accordance with company protocol.
- Maintain AIDET guidelines (acknowledge the patient, introduce yourself, explain the duration or timeline of your process, explain to them what you are doing, and thank the patient for their time).
- Meet or exceed performance objectives including account resolution, established productivity, quality assurance goals, and revenue metrics.
- Pre-arranged travel up to 20% to Client clinics, government agencies, patient homes, or other agreed-upon locations. This position is a Hybrid role (remote & travel) and visits can occur at the clinic during patient appointments with physicians, enrollment fairs, agreed scheduled days for onsite support, and home visits to support patient application enrollment/obtaining signatures and verifications as needed. The Community Engagement Specialist may be required to travel in/out of State on a quarterly basis for 2-3 days to support onsite clinic needs.
- Provide superior healthcare customer service and maintain a professional image.
- Maintain acceptable attendance, appointments, and schedule requirements.
- Multi-task by accessing multiple technologies including but not limited, to host system, electronic medical records, patient portals, phone technology, eligibility verification portals, application portals, provider portals, and internal workflow systems.
- Maintain accurate documentation of patient/guarantor encounters.
- Answer incoming patient or client call/email requests and handle them in a prompt, courteous and professional manner
- Other duties as assigned or requested by Supervisory or Managerial personnel such as acting as backup in other departments.
- Supports Savista Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to Savista business practices. This includes becoming familiar with Savista Code of Ethics, attending training as required, notifying management or Savista Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.
- Develop and maintain knowledge of multiple Federal/State/Other eligibility programs and community benefit programs.
- Act as a backup in creating, reviewing, and providing client reports, as needed.
- Assists team with escalated customer and client issues, and trains other team members as needed, and is a subject matter expert.
- Maintain thorough knowledge of healthcare programs and associated regulatory marketing guidelines.
- Identify and develop relationships with new community contacts and organizations to pursue outreach engagements.
- Identify and coordinate outreach activities and necessary materials at community enrollment events.
- Attend community enrollment events to screen and enroll Beneficiaries into qualified programs.
- Support manager with scheduling and delivery of enrollment education presentations.
- Organize clinic staff and other resources in the participation and the support of select community events and activities
Minimum Requirements & Competencies
- High school diploma or GED.
- 3+ years of experience in a customer service role, interacting directly with customers either in-person or over the phone.
- 1+ years of experience working in a role with a high volume of either inbound or outbound calls.
- Experience working in a role that requires prioritization of multiple critical priorities while ensuring quality and achievements of performance metrics
- Demonstrated experience communicating effectively with a patient and simplifying complex information.
- Experience in a role that requires accessing multiple databases simultaneously or managing multiple open screens to gather information to discuss with a patient.
- Demonstrated ability to navigate Web browser and Microsoft Office. Ability to problem solve simple technology issues.
- Experience with patient interactions that require live, accurate documentation of the encounter.
- Ability to handle sensitive information and maintain HIPAA compliance.
- Maintain acceptable attendance and schedule requirements.
- Proven time management skills.
- Collaborating with leadership to drive financial results.
- Must have a reliable vehicle to drive, and maintain active automobile insurance coverage.
- Must be able to travel from home office to clinics, within cities and states to visit.
- Must be able to adhere to Telecommuting policy.
- Must be able to adhere to Savista travel policy.
- Must have a valid noncommercial driver's license
Preferred Requirements & Competencies
- Bilingual in English and Spanish.
- 2 years of experience working within financial counseling in a Hospital, Physician office or home environment, including demonstrated success obtaining patient demographic and financial information, handling insurance verification, and obtaining authorizations.
- Thorough understanding of federal or state government agencies including Social Security, Medicaid or Charity Care, or healthcare accounts receivable within the healthcare revenue cycle touching patient accounts.
- At least 2 years of experience working in a role with a high volume of either inbound or outbound calls through an automatic dialer
Note: Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $13.13 to $20.63. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.
SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.
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