Eligibility Specialist

Job Description

Job Description

OVERVIEW:

The Eligibility Specialist screens and assists with the application process for federal and state medical assistance programs, Mountain Park Health Center (MPHC) discount program, and other related programs. This position plays a crucial role in ensuring that individuals are screened for eligibility to receive appropriate healthcare services, meet the criteria for these programs, and maintain compliance with established guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Conducts comprehensive needs-based assessments to understand each patient's unique healthcare and financial situation. Uses active listening to identify underlying needs, potential barriers to care, and opportunities for support.
• Verifies patient eligibility for various healthcare programs by gathering, reviewing, and updating personal and financial information. Aligns program options with the patient’s expressed needs and priorities to ensure the most appropriate support is offered.
• Educates and consults with patients on available health benefits using a solution-oriented approach.
• Explains eligibility criteria, guides patients through informed decision-making, and facilitates enrollment while reinforcing the value and benefits of selected programs.
• Assesses financial need by reviewing income statements, tax documents, and other financial records to determine eligibility for assistance programs.
• Prepares and submits applications for medical assistance programs such as MPHC Sliding Fee, AHCCCS (State Medicaid), Supplemental Nutrition Assistance Program (SNAP), and the Health Insurance Marketplace.
• Ensures all required documentation and signatures are included. Maintains strict program compliance by producing high-quality, audit-ready work that meets internal and external regulatory standards.
• Reviews and executes the implementation of new medical assistance programs, and promptly apply all changes mandated by state, federal, and local eligibility programs, including updates to the sliding fee discount.
• Maintains regular and predictable attendance.
• Performs other duties as assigned.

POSITION QUALIFICATIONS:

Minimum Qualifications:

EDUCATION and/or EXPERIENCE:

• Associate degree in Liberal Arts, Human Services, or Business, and two (2) years of experience in eligibility services, benefit qualification enrollment assessment, direct customer services, and application processing; or
• Four (4) years of experience in eligibility services, benefit qualification enrollment assessment, direct customer services, and application processing

CERTIFICATES, LICENSES, REGISTRATIONS:

• Must complete the required certification assessment to process eligibility applications and maintain required eligibility certification annually.

Preferred Qualifications

• Experience in insurance verification and eligibility services.
• Bilingual

As a member of the Mountain Park team, you will have the opportunity to help our community thrive by improving the health of those around you. You’ll work in a supportive environment where you and your coworkers make a difference daily. That’s because how we connect translates to the care we provide our patients. We value professional and personal goals, work/life balance, and family. We are committed to creating a positive work environment and providing our employees with the support and experience to grow and be successful.

Company Description

As a member of the Mountain Park team, you will have the opportunity to help our community thrive by improving the health of those around you. You’ll work in a supportive environment where you and your coworkers make a difference daily. That’s because how we connect translates to the care we provide our patients. We value professional and personal goals, work/life balance, and family. We are committed to creating a positive work environment and providing our employees with the support and experience to grow and be successful.