Eligibility Assistance Services Specialist

Responsible for assessing patient’s eligibility for all available financial programs, ability to pay and available payment alternatives. Makes financial arrangements for patients without insurance coverage; assists patients in obtaining financial sponsorship from outside agencies and charitable programs when financial need is indicated. Researches and collects at point of service on bad debt accounts. Collects patient portions and deposits from patients at the point of service. Serves as a patient representative and advocate working with medical assistance offices and/or third parties in completing appropriate payment and application forms. Pursues acceptance of eligibility and provides recommendations in order to maximize opportunities for reimbursement while minimizing the financial risk to the organization.
 

• Completes frequent face to face patient interactions completing intake application and all required forms. Obtains all documents for verification as defined by the standards.  Determines eligibility for various Ryan White funded services (Part B and C) including HIV medical case management and ADAP, AIDS Drug Assistance Program, as well as other community resources. Schedules medical case management screening appointment.
• Obtains proper HIV status documentation and residency information.  
• Performs the 6 month eligibility review and obtains necessary documents as defined by the standards,
• Complete required data entry into required patient database.
• Demonstrates and applies a thorough knowledge of  benefit programs such as Medicaid, SSI/SSDI, Medicare, TANF, SNAP, Auxiliary Grant, etc. Coordinates with Carilion’s Financial Assistance Program, MedKey, and hospital payment plan eligibility rules, regulations and procedures in order to assure accurate processing of accounts for billing and reimbursement when patient requires additional assistance.
• Maintains current information on all frequently used community resources, as needed.  
• Collaborates with the team to ensure patient timely access to care and access to appropriate resources.