The Eligibility Specialist works on site at an nThrive hospital client, partnering with hospital administration, to help identify financial assistance programs for the uninsured or underinsured customers. They assist with the application process and referrals to all State and Federally funded assistance programs, including but not limited to Medicare, Medicaid, Disability and Charity programs. The Eligibility Specialist, not only acts as an advocate for the customer, but also serves as a liaison between colleagues, clients and State/Government agencies in a collaborative effort to facilitate eligibility coverage for current and future medical expenses.
Works directly with the patient or their representative to inquire about the patient’s potential eligibility for financial assistance.
Provides instructions or works directly with the patient or their representative to complete the appropriate state or federally funded assistance program's application and acquire all necessary releases, signatures and documents.
Directly submits or facilitates the submission of the application and supporting documentation to the appropriate institution in accordance with company protocol.
Informs the patient of all approvals and denials of coverage, if it occurs during the patient’s hospital stay.
Ensures proper protocol including timely and accurate documentation of patient encounters, timely communication with internal colleagues and client hospital administration as well as government staff (as applicable), adherence of patient encounter SLA’s including number of visits per day and communication protocols, and other goals as assigned.
Ensures timely and accurate documentation of all notes and encounters in both nThrive’s database and the client’s database.
Provides a superior experience for the patient and hospital administration while maintaining professionalism at all times.
Supports nThrive’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to nThrive’s business practices. This includes: becoming familiar with nThrive’s Code of Ethics, attending training as required, notifying management or nThrive’s Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.
High School Diploma or GED.
At least 6 months of experience in a clinical facility such as long-term care, behavioral health, rehabilitation, acute care, ambulatory or similar, or federal or state government agency that deals with social security, Medicaid or charity care, or high volume healthcare accounts receivable.
At least 6 months of experience in a role that requires patient interaction, either in person or over the phone.
Experience dealing with multiple databases to document patient interactions and retrieve related information that is important to understand the detail necessary to achieve the desired outcome.
Ability to handle sensitive information and maintain HIPAA compliance.
Demonstrated ability to navigate Internet Explorer and Microsoft Office.
Experience working with internal and/or external stakeholders to gather or share information, or to collaborate together to achieve the desired outcome.
Experience working in a role that requires prioritization of multiple critical priorities while ensuring quality and achievement of performance metrics.
Demonstrated ability to meet or exceed performance metrics.