Health Eligibility & Access Supervisor Agency Description : San Francisco Community Health Center is a federally qualified health center that provides culturally competent high quality medical care, mental health services, education, and outreach. We are a safety-net for the LGBTQ community, the unsheltered community, people who use substances, and those with mental health needs. We are an anchor-organization for San Francisco's Tenderloin neighborhood, and we also lead regional, statewide, and national programming.
We believe that everyone deserves access to the highest quality care served with dignity and respect. About You : - You focus and center your work around giving a high level of service.
- You are empathetic in responding to any situation with compassion and curiosity.
- You are driven by your own internal integrity as well as that of the agency.
- You have a justice and equity mind-set.
- You feel that everyone deserves dignity and respect.
- You consistently pay attention to details.
- You collaborate well in a diverse and interdisciplinary workplace.
Role Summary: The Health Eligibility & Access Supervisor plays a pivotal role in the new Clinic Revenue Operations unit San Francisco Community Health Center (SFCHC). This new role reports to the Revenue Cycle Manager and ensures accurate, complete, and timely submission of claims for medical, dental, mental health and enhanced care management (ECM). The Health Eligibility & Access Supervisor administers Sliding Fee Discount Program ensuring everyone will have access to whole person care regardless of ability to pay. This role will work collaboratively with the ECM unit and our third-party provider, Ochin Billing Services (OBS). Health Eligibility and Access Supervisor supervises 2 eligibility and 2 patient engagement specialists. This role works on site, full-time.
Essential Duties : - Ensure that patient registration is fully staffed and front desk is open at designated hours
- Assist in completing new patient Medi-Cal applications, renewals, and eligibility verifications
- Verify Medi-Cal and managed care plan status through online portals such as BenefitsCal, DHCS-Medi-Cal, San Francisco Health Plan and Anthem Blue Cross MCPs
- Liaise with San Francisco Health Plan and Anthem Blue Cross MCPs and county Medi-Cal offices to resolve application or coverage issues.
- Accurately review and scrub pending charges to ensure timely closeouts and billing
- Review and verify the completeness of claim documentation for Medi-CAL-AIM services
- Investigate and resolve discrepancies, denials, disallowance or issues
- Collaborate with the eligibility, patient registration and ECM care teams to gather necessary information for billing purposes
- Maintain accurate, complete, and relevant documentation of SFCHC's Sliding Fee Discount patients in Epic (EHR) and in digital files
- Generate a masked list of ECM and SFD patient encounters weekly and monthly for CFO and clinical team
- Collaborate with SFHP-Anthem MCPs, DHCS Medi-Cal representatives and regulatory bodies, to facilitate smooth billing processes
- Assist in new provider plan enrollment and credentialing serviced by Provider Passport
- Coordinate all billing issues with Ochin Billing Services (OBS) and clinical operations team
- Support the RCM in monthly compliance reporting requirements to the CFO and CMO
- Recruit, train, coach and guide professional development of staff reporting to this position.
- Provide administrative support in annual financial audit, HRSA on site visit and plan visit review
- Participate in periodic check-in or huddle with the RCM and ECM care teams
- Perform other duties as assigned
Qualifications and Requirements :
- At least junior college or associate undergraduate, a bachelor's in healthcare management, accounting or business management or a related field is preferred.
- Completion of valid certification in medical billing or coding or must undergo a certification within 90 days from hire
- Minimum of 5 years of experience in billing and claims processing, with a focus on Medi-Cal, Medicare and sliding discount programs
- In-depth knowledge of the DHCS Cal-AIM program regulations, guidelines, and billing procedures
- Proficiency in using billing software and electronic health record (EHR) systems, Epic is a plus
- Strong attention to detail and accuracy in claims submission and documentation
- Excellent communication skills and the ability to collaborate effectively with cross-functions
- Detail oriented, focused, and exemplifies discretion in handling patient health information
- Comfortable and culturally competent in working with LGBTQ communities
- Experience in supervision of a diverse team of staff who serve marginalized communities.
- Must pass a full background check and LEIE reference check
Benefits : Competitive compensation
Comprehensive health, vision, and dental insurance
Company sponsored life, and long-term disability insurance
Generous paid time off including paid holidays
Company-sponsored retirement plan
Opportunities for professional growth and development
EEOC Statement : San Francisco Community Health Center is an equal opportunity employer committed to identifying and developing the skills and leadership of people from diverse backgrounds. San Francisco Community Health Center does not discriminate based on age, ancestry, citizenship status, color, creed, disability status, gender identity, HIV status, marital status, medical condition, genetic information, national origin, pregnancy, race, religion, sex, sexual orientation, veteran status, or any other legally protected class.
