The Eligibility Analyst will focus on the Good Faith Estimate (GFE) work queue, educate patients on their financial obligations to the facility and follow up with patients and other parties to ensure accuracy and completeness of the information. Analyst will interview patients and problem solve with patients lapses in insurance.

Essential Functions & Responsibilities

The Eligibility Analyst will has the following responsibilities and duties:

Good Faith Estimates

• Review and validate all items in good faith estimate work queue in advance of patient visits.
• Ensure good faith estimate notices are prepared in a timely manner and provided to patients through email, by mail, or in-person.
• Contacts patients to ensure they have received and understand their GFE prior to attending their appointment and provides follow-up communication when patients have not received their good faith estimate notice.
• Assures that once an item or service has been scheduled or a request for a good faith estimate has been received, the GFE is provided per established timeline as outlined in MNHC policy.
• Ensures staff scheduling patient appointments understand the requirement for informing uninsured and self-pay patients of their GFE right.
• Assists patients in understanding the GFE dispute resolution process.
• Assists patients with financial applications and arrangements
• Facilitate collection of estimated liabilities from patients

Patient Coverage Status Verification

• Review and validate all items in patient coverage status not verified work queue.
• Works closely with Billing Manager to identify and resolve trends and issues.
• Establish the patient’s health insurance benefits, conditions and requirements by making phone inquiries, using eligibility verification systems and completing health plan website inquiries.
• Updates patient insurance information using electronic medical record system.
• Identify and help schedule appointments for patients who are due to update their annual registration per MNHC guidelines to assure program eligibility.
• Work with patients who qualify for the sliding fee scale, are uninsured, or on Medi-Cal to problem solve their interruptions to medical coverage including, but not limited to facilitating calls to the health plans.

Administrative Functions

• Working with internal analysts, develops reports that inform the organization’s ability to streamline patient notification of good faith estimates, patient registration and eligibility protocols.
• Provides feedback to staff on strategies and practices to sustain patient enrollment.
• Assists with training MNHC staff to notify uninsured/self-pay patients about their right to receive a good faith estimate prior to their medical appointment.
• Attending and participating in meetings, training and presentations as required.
• Serve as back-up resource to interviews patients to secure demographic information, registers or renews registration for individuals, and families as MNHC patients; enters patient information into the electronic health record to ensure registration information is complete.
• Other duties as assigned by supervisor.

Qualifications

The Eligibility Analyst should have the following skills, education and experience:

• Bilingual in English and Spanish is required.
• A Bachelor’s Degree or relevant and equivalent work experience.
• Effective verbal and written communication skills.
• Knowledge of third-party payers and associated regulations.
• Strong computer skills including intermediate MS Office skills, internet research and experience with database systems.
• Ability to work autonomously with focused direction
• Ability to problem solve, advocate, and represent MNHC patient’s concerns with health plans.
• Minimum 1 year experience working in a healthcare environment
• Experience working with Latinx Immigrants preferred
• Experience working with low-income families preferred
• Epic or other electronic medical record system
• MS Office Suite
• Experience navigating health plan websites

Who We Are: The Mission Neighborhood Health Center (MNHC) is a non-profit, multi-site community health organization offering comprehensive health services in the Mission and Excelsior Districts of San Francisco. We offer primary health care services including adult medicine, pediatrics, behavioral health, family planning, OB/GYN, HIV, homeless services, optometry and dental services. We advocate for health equity and deliver innovative, high quality services responsive to the neighborhoods and diverse communities we serve with a focus on the Latino Spanish-Speaking Communities.

Benefits:

• Medical Insurance – MNHC pays 90-100% based on plan
• Dental and Vision Insurance – free to employee
• Flex Spend Accts for health & dependent care expenses
• Life Insurance – free basic policy plus voluntary option
• Vacation – 2 weeks (3 weeks after 5 yrs; 4 weeks after 8 yrs)
• 12 Paid Holidays plus your birthday and 12 Sick Days each year
• 40 hours Paid Educational Leave
• 401k Retirement Savings Plan with Company Contribution

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