Elica Health Centers · 2 months ago
CalAim Financial Counselor
North Highlands,CA,US
Full-time
Onsite
Entry, Mid Level
$23/hr - $26/hr
2+ years expElica Health Centers is dedicated to providing exceptional healthcare services to underserved patients. The CalAim Financial Counselor will be responsible for verifying client eligibility for the Enhanced Care Management program, coordinating service referrals, and ensuring proper documentation for billing and reimbursement. This role is crucial in supporting the ECM team and enhancing patient care within the community.
Alternative MedicineFacilities Support ServicesFitnessHealth CareNon Profit
Responsibilities
Perform pre-outreach activities for new clients referred by Managed Care Plans (MCPs), such as verifying eligibility, adding an appropriate Guarantor Account and Episode to EHR
Independently Manages at least one ECM Referrals EPIC WorkQueues by actively monitoring referral statuses and processing new referrals
Tracks the status of authorization requests
Tracks and resubmits re-authorization requests as required by MCPs by coordinating with ECM Care Managers
Coordinates with the CalAIM Quality Assurance Specialist and CalAIM Reimbursement Specialist to track and update authorizations issued by MCPs
Checks eligibility of members in outreach and enrolled programs stage at the minimum of twice a month
If a patient switches MCPs and Elica is in contract with MCP for ECM, submits and tracks prior-authorization
If the patient loses coverage, is no longer enrolled into any MCPs or switches MCP to one not contracted for ECM services, notifies an appropriate ECM Care Manager or Community Health Worker to work with the patient on either regaining coverage or transferring to Health Plan for reassignment to a contracted provider
For patients internally referred to ECM, checks patients’ eligibility for contracted ECM and CS services
Coordinates with the CalAIM Reimbursement Specialist and CalAIM Billing Specialist in regards to billing issues
Assists the CalAIM Manager in maintaining accurate program enrollment data and flagging program enrollment discrepancies
Provides accurate data entry of referral or authorization information into the electronic medical record
Consistently utilizes the department's documentation protocols
Assists with the Resource Center visitors who are interested in being in the ECM and/or CS program by educating them on the program and program eligibility
Attends Team and Managed Care Plan meetings
Maintains consistent attendance and punctuality
Other duties as assigned
Qualification
Required
Minimum of an Associate degree in any field and minimum of two years of experience with eligibility and/or referrals OR a minimal experience of 3 years in eligibility and/or referrals related field
Computer and technology skills
Excellent computer skills in a Microsoft Windows environment. Must include knowledge of Excel and skills in Google Workspace
Better than average written and spoken communication skills
General knowledge of various MHPs and state programs
Excellent organizational and time management skills
Ability to work with minimal supervision and use good judgment, at times under the pressure of deadlines
Adherence to all Elica policies including but not limited to: standards of conduct, time and attendance
If selected for an employment opportunity with Elica Health Centers, external hires must provide proof of immunizations (Hepatitis B, MMR, Varicella & Tetanus), tuberculosis clearance, and proof of COVID-19 vaccination status prior to their scheduled start date
This position is subject to criminal background investigation and drug screen
This position is non-exempt and subject to timekeeping requirements
Employees are required to clock in and clock out accurately at the beginning and end of each shift, as well as during meal and rest breaks
This is a fully on-site, office-based position (5735 Watt Avenue, North Highlands, CA 95660)
The work environment is characteristic of normal office conditions
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job
While performing the duties of this job, the employee is frequently required to sit; use hands to handle or lift
The employee is occasionally required to stand; walk; and reach with hands and arms
The employee must occasionally lift and/or move up to 20 pounds
Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus
The employee must also possess hearing and speech to communicate in person and over the phone
The noise level in the work environment can range from quiet to moderately loud; the incumbent must be able to focus in an environment with many distractions
The employee may be required to run agency related errands and attend off-site meetings; the employee must be able to operate, maneuver and/or control a motor vehicle
In performing the driving responsibilities, the driver may sit for long periods. This requires intense concentration, particularly in poor driving conditions
Preferred
Prior experience with CalAIM programs - Preferred but not required
Prior experience using Electronic Health Records systems- Epic Preferred
Benefits
403(b) retirement plan with up to 4% employer matching and 100% immediate vesting
Two Anthem Blue Cross PPO plans for medical, plus dental and vision coverage for you and your family
Health Reimbursement Arrangement
Health Care FSA and Dependent Care FSA
Company-paid basic Life and AD&D Insurance
Hospital Indemnity, Critical Illness, and Accident Insurance
ID Theft Protection
Pet Insurance
Accrued paid time off
Paid holidays
Employee Assistance Plan (EAP)
Tuition Reimbursement Program
CME/CEU and license reimbursements
Company
Elica Health Centers
Elica Health Centers is health care center and partnership with other organizations.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$0.7M2015-05-11Grant· $0.7M
Leadership Team
Tatyana Flek
Acting Chief Executive Officer
Aide Long
COMMUNITY OUTREACH SERVICES DIRECTOR
Recent News
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