Eligibility Specialist

Under the direction of the Director Patient Access, this position ensures that patients receiving services from Valleywise Health have been properly screened for self-pay financial assistance. This position is responsible for gathering thorough documentation and entering information into various systems. This position ensures that all compliance policies are monitored and followed. Ensures accurate and timely processing of all accounts as well as registers patients while ensuring accurate and timely processing of all accounts. This position obtains necessary verification of insurance and other eligibility programs. Initiates and assists patients in completing the AHCCCS application. Tracks and monitors the completion of the AHCCCS application. Performs quality checks on all eligibility/AHCCCS applications initiated in the department and ensures they are processed on every self pay or unverifiable payer source. Also performs quality assurance checks on the AHCCCS application program and works with management and other staff to identify and resolve issues that threaten billing and reimbursement.

Qualifications:

Education:

• Requires a high school diploma or GED.

Experience:

• Must have a minimum of two (2) years of progressively responsible interviewing/investigative experience in obtaining confidential information and direct experience with the AHCCCS application process that demonstrates an understanding of the required knowledge, skills and abilities.

Specialized Training:

• None

Certification/Licensure:

• Must have a valid fingerprint clearance card issued by the Arizona Department of Public Safety OR submit a completed Affidavit at time of hire. Must complete fingerprint clearance card application within seven (7) days of hire date. Must present actual card within 90 days of applying for fingerprint clearance card.

Knowledge, Skills & Abilities:

• Requires excellent data entry skills including, 10-key by touch, and the ability to type 30 words per minute accurately.
• Basic math skills required. Insurance verification and Medicaid eligibility experience highly desirable.
• Must be able to demonstrate interviewing and investigative techniques in order to obtain information that may not be offered.
• Must possess good interpersonal and communication skills both verbally and in writing including knowledge of basic grammar, spelling & punctuation.
• Requires the ability to read, write and speak effectively in English.
• Critical thinking skills are strongly preferred.
• Must be able to handle multiple tasks simultaneously.