Patient Services Specialist

POSITION SUMMARY:   The Patient Services Specialist, under the supervision of the Medical Office Manager, provides in person support to individuals and families registering as new patients and applying for insurance at Sonoma County Indian Health Project, Inc. (SCIHP). The PSS interviews applicants, determines eligibility for SCIHP services, and helps the patient understand available healthcare and coverage options. This role mages the full cycle of benefit applications including initiation, tracking, follow up, processing, and reporting. As a key point of contact, the PSS ensures patients are connected to the care and resources they need. 

ESSENTIAL FUNCTIONS: 

Certified Enrollment Counselor:

1. With patient’s express permission, enroll individuals and families into Medi-Cal and/or Covered California programs by screening for eligibility and gathering required documentation.
2. Verify identification, including Tribal verifications.
3. Determine which patients may be eligible for health insurance programs and schedule appointments to follow up with personal contact.
4. Assist with the entire health insurance enrollment process, including providing insurance options available, educating patients about cost sharing, coverage effective dates and maintaining coverage.
5. Assist individuals and families with Medi-Cal and/or Covered California renewals and reapplications. 
6. Tracks and prepares reports on the number of applications processed as well as number of incomplete applications pending additional information monthly and as requested by supervisor.
7. Records and evaluates personal and financial data obtained from individual and families determine initial or continuing eligibility, according to departmental/SCIHP directives.
8. Proactively contact patients who may be eligible for health insurance programs and offer assistance with applying for coverage.
9. Maintain up-to-date understanding of Medi-Cal and Covered CA benefits information and provide information to SCIHP personnel and patients as needed regarding changes to insurance eligibility requirements or covered benefits.
10. Coordinate service and benefits between SCIHP and California and county agencies on behalf of patient benefits, as requested and permitted by the patient.
11. Encourages patients to seek help from the programs available through SCIHP and California and county agencies.
12. Attends and participates in monthly meetings, trainings as scheduled.
13. Performs other duties as assigned.

Patient Registration/Eligibility:

1. Schedules appointments with individuals and families to screen for eligibility and obtain required information, Tribal documentation and other information as needed to complete new patient registration.
2. Register new patients verifying the patient meets all the eligibility requirements and provides all necessary documentation.
3. Validates Tribal documentation that has been provided. 
4. The Patient Services Specialist is broadly responsible for identifying and addressing deficiencies in registered patients’ record files that may impact patient eligibility and/or influence decision-making regarding Purchase Referred Care (PRC) patients.
5. Maintain a current and accurate understanding of rules and regulations governing SCHIHP patient eligibility and specific service-line eligibility within SCIHPs programs.
6. Identifies need for social services and makes referrals to various agencies and community resources available.
7. Prepares regular and special reports as required and submits individual recommendations for consideration by supervisor.
8. Electronically register new, eligible patients, assuring all necessary documentation is appropriately and accurately entered into the Electronic Medical Record system and that necessary documents are scanned and correctly indexed.
9. Provides timely follow-up on the approval or denial of patient applications. 
10. Obtains/ updates patient information in the Electronic Health Records (EHR) system.
11. Reviews note in the EHR system verifying registration is up to date.  
12. Performs other duties as assigned.

EDUCATION AND EXPERIENCE:  

1. High School diploma or general education degree (GED).
2. Achieve the Certified Enrollment Counselor Certificate within three months of hire.
3. Two (2) years' experience performing clerical duties, including substantial public contact with patients in a health care setting preferred.
4. Must maintain a valid, unrestricted California Driver’s license and ability to be insurable under SCIHP’s automobile insurance and be able to meet insurance requirements regarding driver record in order to utilize GSA vehicles.
5. Possess current CPR certification or obtain it within 90 days from hire.

QUALIFICATIONS:

1. Must comply with Federal and California laws regarding the use and disclosure of individually identifiable health information, with the provisions of the Health Insurance Portability and Accountability Act (HIPAA), and the Health Information Technology for Economic and Clinical Health Act (HITECH).
2. Ensure the confidentiality of all applications, records, and any information received in writing, verbal, or other forms.
3. Basic interviewing skills for the purpose of gathering information and explaining policies or clarifying information as needed.
4. Greet all patients and visitors in a warm and friendly manner.
5. Demonstrates knowledge of available health benefit programs with Medi-Cal and/or Covered California plans.
6. Establish and maintain constructive working relationships.
7. Proficient in MS Office (Word, Excel and Outlook), Electronic Health Record (EHR).
8. Ability to operate standard office equipment (Fax, Copier, etc.).                                        
9. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. 
10. Ability to write routine reports and correspondence. 
11. Prepares and maintains appropriate files, documents and records of cases.
12. Excellent communication skills, both written and verbal.
13. Participates in quality improvement activities as assigned.
14. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
15. Ability to apply common sense understanding to carry out instructions both written, and verbal form.
16. Some travel may be required.
17. Must pass a pre-employment drug screen, physical and background investigation. 
18. Must provide proof of completed COVID vaccines.

SPECIAL QUALIFICATIONS:Must be sensitive to the needs of the Native American Indian community which includes culture, traditions, and background.