Job Description

The Patient Enrollment Specialist (PES) is responsible for onboarding patients into NATIVE HEALTH’s Integrated System of Care. The PES.facilitates enrollment of individuals and families into affordable health and dental insurance coverage such as Arizona Health Care Containment System (AHCCCS) and KidsCare. Provide insurance plan information such as commercial health plans and the Marketplace. The PES processes NATIVE HEALTH Discount Program (formerly known as SFS) applications for the uninsured and the underinsured as needed. The PES collects documentation for eligibility for services and special provisions for American Indians and Alaska Natives. The PES also links program participants and their families with community health resources to address social needs.

KEY ACCOUNTABILITIES:

1. Provides excellent customer service to patients, visitors, and staff in person and on the phone.
2. Manages patient pre-registration, registration and eligibility of insurance for all new and current patients.
3. Provide education, advocacy and enrollment assistance for Medicaid, Health Insurance Marketplace, other health plan options, SNAP, and TANF.
4. Responsible for enrollment and compliance with the Discount program available for all patients and fee waivers available for AI/AN patients.
5. Collect and process accurate payments from individual patients.
6. Supports the organization as needed.

KNOWLEDGE, SKILLS AND ABILITIES:

1. Must have good communication skills, both written and verbal.
2. Capacity for self-motivation and ambition with minimal supervision.
3. Expert knowledge regarding eligibility requirements and enrollment process of the Sliding Fee Scale program, AHCCCS, CMDP, Title V, SNAP, and TANF.
4. Ability to uphold quality customer service to all patients/customers of NATIVE HEALTH.
5. Demonstrate proficiency with computer-based applications such as MS Office, Adobe, spreadsheets, email, and other computer software programs.
6. Able to use medical Electronic Health Record Systems.
7. Ability to complete health plan eligibility and pre-authorizations.
8. Understanding of eligibility, enrollment, and access barriers to health care issues of the Native American/Hispanic and other minority communities of Maricopa County.
9. Ability to work with multiple levels of supervision and differing program requirements simultaneously.
10. Knowledge of privacy and confidentiality policies and regulations.
11. Ability to communicate with co-workers and superiors to carry out assignments, meet goals and ensure the success of the position.
12. Maintain current knowledge of public benefit programs and web-based benefit application sites.
13. Stay well-informed of and communicating health-related information regarding all services NATIVE HEALTH offers.
14. Excellent customer service skills.
15. Must understand diverse communities, backgrounds, and cultures.
16. Must adhere to all standards relating to Culture and Linguistics Appropriate Services (CLAS).

Qualifications

1. High School Diploma or equivalent with five years combined experience in customer service, health care advocacy and education, patient registration, or other direct care medical experience.
2. Associate degree preferred.
3. Bilingual in English/Spanish languages preferred.
4. Must be flexible in work hours, including Saturday hours.
5. Must be flexible to work at any location as needed, e.g., clinics and outreach.

Standard Employment Requirements

1. Must possess a valid and unrestricted Arizona driver’s license (within 30 days of hire if applicant is from out-of-state) with no DUI/DWI or reckless driving convictions in the last five years. No more than two at-fault accidents in the last three years. Must maintain a valid Arizona driver’s license during employment. Must be insurable under NATIVE HEALTH’s liability auto policy.
2. Must pass a criminal background check and obtain a Class I Fingerprint Clearance Card within the initial ninety (90) calendar days of employment and retain a valid card while employed with NATIVE HEALTH.
3. Must pass substance abuse testing upon employment and submit to random testing during employment.
4. Must provide an updated immunization (IZ) record at the time of employment.
5. Must have a current (within 12 months) Tuberculosis (TB) skin report upon employment and provide an annual update.
6. Must obtain BLS certified within (90) calendar days of employment and maintain certification during employment.

Additional Information

Native Health complies with all state and federal requirements, including EEOC requirements.