Position Title: Enrollment Specialist

Status: Full-Time – Union

Department: Membership Enrollment Services

Reports to: Membership Enrollment Manager

Summary of Experience:

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:

• 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; and
• 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 (i.e., current and newly supported) comply with and successfully complete all required and applicable federal and/or state consumer assistance training, as is required for all assistance personnel carrying out consumer assistance functions.
• 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-Cal.
• Enters 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 County.
• Assist 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:

• Experience in a medical office setting preferred.
• Certified CAA
• Ability to handle multiple tasks and work in a busy environment.
• Must have great verbal and written communication skills,
• English and Spanish is a MUST
• Computer 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.
• Able to work and communicate effectively with people of diverse culture, education, social and economic backgrounds.
• High School Diploma or Equivalent.
• Must provide proof of up-to-date COVID-19 vaccinations including recommended doses in the primary series AND booster dose when eligible.