Enrollment Specialist The Enrollment Specialist will demonstrate and maintain expertise in eligibility and enrollment rules and procedures; the range of qualified health plan options and insurance affordability programs; the needs of underserved and vulnerable populations; and privacy and security standards.
Responsibilities include:- Conduct public education activities to raise awareness about coverage options available under Medicaid, CHIP and the Marketplace
- Help individuals understand and access affordability options
- Provide information and assistance in a fair, accurate, and impartial manner
- Provide information and assistance in a manner that is culturally and linguistically appropriate to diverse communities and accessible to individuals with disabilities
- Provide referrals to any applicable office of health insurance consumer assistance or ombudsman established under Section 2793 of the PHS Act to address consumer grievances, complaints, or questions about their health plan, coverage, or a determination
- Ensure all health center outreach and enrollment assistance workers comply with and successfully complete all required and applicable federal and/or state consumer assistance training
- Demonstrate the capacity to conduct "in reach" with currently uninsured health center patients and "outreach" to non-health center patients in their approved service area
- Health center outreach and enrollment assistance workers will be required to help any patients or residents seeking outreach and enrollment assistance
- Must provide timely referrals to other resources, such as the toll-free Marketplace Call Center, or to other state or local entities that can more effectively serve that individual
- Screens and enrolls patients under programs they may qualify for, such as HWLA-Matched, HWLA-Unmatched and Medi-CalEnters and retrieves patient medical data from computer terminal updating entries as necessary
Is familiar with Medi-Cal, Healthy Families, Healthy Kids, Healthy Way L.A., Kaiser Child Care Plan and other health care options available to parents, child care providers and the general public in Los Angeles CountyAssist in the compilation of data for regular and special reports (e.g. grievance reports)
Assist in the training of new personnel
Effective Assistance for members and families experiencing difficulties (e.g. enrollment trouble shooting and advocacy on behalf of the family, barriers to enrollment, utilization and retention) and offer retention assistance
Provide on phone or in person accurate, reliable information regarding Clinica's Medi-Cal Programs
Ensure patients are enrolling in Medi-cal, Healthy Way L.A. and any other health care options available
Demonstrates a positive, can do attitude in responding to employee and patient needs
Provide education to patients on Medi-cal application process and how to advocate for themselves
Attends In-Services and/or trainings
Call managed care patients for appointments
Update EPIC with notes in order for front office to process patients with appropriate HWLA status
Answers incoming calls for HWLA and Medi-cal patients, takes messages, transfers calls and provides information to other departments upon request
Operation of standard office machine
Other duties assigned
Qualifications include:- Experience in a medical office setting preferred
- Certified CAAAbility to handle multiple tasks and work in a busy environment
- Must have great verbal and written communication skills
- English and Spanish is a MUSTComputer experience and typing at least 45 wpm
- Able to promote and provide means for a working team relationship with front office and other departments
- Able to handle heavy telephone duties and an influx of patients
- Organized, flexible, thoroughness, dependability and attention to detail
- Must be able to communicate effectively with people of diverse culture, education, social and economic backgrounds
- Must have strong team orientation
- High School Diploma or Equivalent
