Eligibility Specialist III - MISP (Finance)

Applications will be reviewed in the order in which it was received

The bilingual Eligibility Specialist III is a lead-level position within RUHS Medical Center's Patient Access/Eligibility Services team. This role is responsible for auditing the work Eligibility Specialists I and II to ensure compliance with applicable policies, procedures, and regulatory requirements. The incumbent provides on-the-job training to both new and experienced staff, offering technical guidance and support to promote accuracy and efficiency in eligibility determinations.

This position plays a key role in conducting face-to-face interviews and screenings with patients and the public to determine eligibility for a wide range of healthcare and public assistance programs, including County, State, and Federal programs. Proficiency in using electronic health record systems such as EPIC is highly desirable, as is familiarity with Medi-Cal, Covered California, and other government assistance programs. Although a background in a hospital setting is not required, it is considered a highly desirable.

The bilingual Eligibility Specialist III also coordinates and assigns daily tasks to eligibility staff, ensuring adequate coverage and timely processing of applications. The role requires strong organizational skills and the ability to monitor workloads and adjust assignments as needed. In addition, this position serves as a liaison with the Department of Public Social Services (DPSS), Case Management, and other internal departments to ensure effective communication and coordination in case handling.

This position assists the Eligibility Supervisor with routine operational tasks, special projects, and may serve as a lead in the Supervisor's absence. The incumbent is expected to prepare clear and concise reports related to audit findings, eligibility metrics, and productivity trends. Strong communication skills, knowledge of healthcare eligibility requirements, and the ability to work independently and as part of a team are essential for success in this role.
Schedule: Monday through Friday - 8:00 am-4:30 pm

Location: 26520 Cactus Ave. Moreno Valley CA 92555

Bilingual: Spanish/English, required

The Riverside University Health System is here for you when you or someone you love is in need of help to achieve and maintain a life of whole health wellness and recovery. Can you see yourself here?• Initially participate in a training program consisting of formalized training and on-the-job training which would give instruction to learn the typical duties performed by the journey level classes.

• Interview applicants for and recipients of one or more aid categories to assist them in the completion and clarification of the application and declaration forms upon which eligibility decisions are based; conduct such interviews in the Medically Indigent Services Program (M.I.S.P.) offices, clinics or in the hospitals.

• Obtain pertinent information concerning such items as income, other financial resources and financial obligations/debts from applicants and recipients; obtain additional information to resolve discrepancies in the applications and declarations by telephone, correspondence or personal interviews.

• Determine eligibility in accordance with established procedures; record information for case records; interpret program regulations and other pertinent material to applicants, recipients and the general public.

• Compute amount of grant authorized and perform other similar required computations; may prepare and maintain other documents associated with the eligibility determining process.

• On the basis of observation, or of need expressed by applicant orally or in specified locations on the applications and declaration forms, refer all applicants and recipients who appear to need social services to designated staff members after completing the appropriate referral forms.

• Review, evaluate and investigate selected cases to determine the accuracy and completeness of all statements of fact given by applicants or recipients during initial and continuing eligibility determinations.

• Contact and interview applicants, recipients, individuals and representatives of business or government organizations for the purpose of verifying facts and/or resolving discrepancies pertinent to the correct determination of eligibility.

• Prepare written reports with recommendations for appropriate corrective action when additional facts affecting eligibility are established and/or prepare written reports justifying the eligibility determination made by the Department in cases appealed by clients.

• Interpret policies, rules and regulations to public officials, clients and the general public; write correspondence.Education: Graduation from high school; possession of a certificate of proficiency issued by the California State Board of Education; or a GED diploma.

Experience: One year of performing duties comparable to Riverside County Health Services Agency's Eligibility Specialist II classification in the Medically Indigent Services Program.

Knowledge of: The goals of public social service agencies, hospitals and health care facilities; the basic laws, rules, and regulations governing eligibility and grant determinations for public assistance programs; interviewing and record keeping techniques; problems requiring referral to the staff; standard office procedures and practices.

Ability to: Interview effectively in a variety of settings; accurately gather, record, and correctly evaluate data necessary for the determination of eligibility for various public assistance programs, correctly interpret the rules and regulation governing eligibility determinations to applicants, recipients, and general public; speak and write effectively; maintain accurate and systematic records identify problems requiring referral to other Department staff. Other Requirements

License/Certificate: Possession of a valid California Driver's License may be required.

Bilingual Testing

The Human Resources Department will coordinate a Bilingual (Spanish) Non-Proctored Assessment.

County of Riverside Human Resources Contact:

For more information regarding this position, please contact the recruiter, Jammie Smith, via email at jasmith@rivco.org.