Job Description

NAME:

TITLE:Eligibility Specialist/Referral Coordinator

REPORTS TO:Director of Behavioral Health

WORK WEEK:Hours not to exceed 40 hours per week

WAGE CLASSIFICATION:Non-exempt

OSHA CLASSIFICATION:Low

SUMMARY POSITION STATEMENT

This position is the central point of contact for intake for Behavioral Health services, facilitating payment for services, and assuring that the customer is referred to the appropriate in-house or outside provider. Duties include:

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  • Informs patients about X policies and procedures regarding enrollment, payment for services, and services provided.

X / X /
  • Informs customers about documents necessary for establishing care, including but not limited to prior treatment records, insurance and payment information, legal documents related to custody and guardianship.

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  • Directs customers to appropriate X services based on information obtained in a brief screening process

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  • Coordinates behavioral health referrals from external and internal sources, and facilitates appropriate placement into X services.

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  • Completes initial verification of insurance benefits.

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  • Reviews proof of household income documents to determine eligibility for discounts/sliding payment scale.

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  • Determines customer’s pay rate based on the Eligibility Determination Worksheet and inputs the information.

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  • Explains customer’s obligations for payment under X policies and procedures.

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  • Facilitates the process for customers to access outside financial assistance.

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  • Based on determination of customer’s pay rate, in the case of no health insurance, reviews X and referral treatment options

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  • Updates eligibility and financial information on a regular basis.

ESSENTIAL FUNCTIONS/ROLES & RESPONSIBILITIES OF THE POSITION

  • Functions in accordance with and in support of X mission, vision, policies and procedures.
  • Identifies payment source and amount of discount if self-pay.
  • Interviews customers in order to make initial determination of appropriate BH service (e.g., psychiatry, Level I, Level II, emergency, etc.)
  • Establishes a positive working relationship with outside agencies; develops a collaborative working relationship with contact person.
  • Coordinates with Xcase workers and resources to facilitate a customer’s application process to outside agencies; whenever applicable, completes intra-agency referrals.
  • Refers all billable services to an appropriate in-house staff member.
  • Is thoroughly familiar with X eligibility determination policies and procedures.
  • Has access and a basic understanding of all agency practice management systems.
  • Consistent attendance and punctuality is required and expected to work the hours set by X and/or the schedule set by supervisor.
  • Expected to complete required trainings such as CPR, Mandt, Mental Health First Aid and any others deemed necessary for this position.

OTHER DUTIES & RESPONSIBILITIES OF THE POSITION

  • Maintains current knowledge about service/program options within the community and state.
  • Performs other job duties and responsibilities as assigned.

LEGAL CONCEPTS

  • Maintains confidentiality.
  • Follows federal, state and local legal guidelines.
  • Maintains HIPAA compliance.

POSITION REQUIREMENTS

Education: High school diploma or the equivalent.

License: No license required.

Experience: 3-5 years experience in healthcare.

Job Requirements:

  • Possess “people” skills and enjoy working in a health care setting; and be able to listen and communicate effectively.
  • Possess and utilize effective organizational skills.
  • Be able to work effectively and productively in a high stress and high “needs” environment serving the under and uninsured population.
  • Be able to operate telephone system andmaintain functions of all computerized systems.
  • Must possess basic math skills.
  • Proficient in use of Microsoft Office applications: Word, Excel and Outlook.
  • Maintains positive behaviors, communications and other outward expressions regarding X.
  • Maintains positive, constructive, cooperative and professional working relationships with coworkers.
  • Seeks to continuously improve skills and knowledge.
  • Expected to read and respond timely to emails via Outlook.

TYPICAL PHYSICAL DEMANDS

  • Prolonged sitting; occasional bending, stooping and stretching.
  • Requires eye-hand coordination and manual dexterity sufficient to operate office equipment.
  • Requires normal range of hearing and eyesight to record, prepare appropriately.
  • May be occasional lifting up to 15 pounds.

CORE VALUES

  • Treat all co-workers and patients with dignity and respect.
  • Project a professional manner and image.
  • Adhere to ethical principles.
  • Communicate professionally andeffectively; focus on cooperation and win/win outcomes; maintain a positive attitude.
  • Serve asa Community Liaison.
  • Follow and enforce the mission of PCHS.
  • Abide by the policies and procedures outlined by PCHS including the Employee Manual.
  • Report any safety and/or health concerns to management as soon as they become apparent.
  • Expected to bring your best work and attitude to PCHS.
  • Expected to handle complaints and grievances professionally, adhering to the employee manual and to uphold employee core values as outlined in this job description.

JOB RELATIONSHIPS

  • Reports to and receives direction from the Director of Behavioral Health.
  • Does not supervise any other employees.

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Supervisor DateEmployee Date