Medicaid Enrollment Specialist - Experience Required

Our Mission

We meet people where they are and partner with them on their journey towards wellness.

Our Vision

The destination for servant leaders to provide comprehensive and exceptional care.

Our Values

R - Respect

I - Innovation

S - Stewardship

E - Excellence


COMPENSATION: The base pay starts at $18.60/hr and has the potential to increase with years of experience.

Outreach and Enrollment Specialist Summary

Collaborate with the clinical team and families of patients to enroll eligible patients in insurance programs. Duties and responsibilities include increasing access to care through application and enrollment assistance for people who may be eligible for the new affordable insurance options available beginning in 2014.


A Day in the Life

This job description reflects management's assignment of essential functions. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.


• Respond to incoming requests for assistance regarding the application and enrollment process.


• Provide information in a fair, accurate, and impartial manner.


• Remain current with eligibility requirements.


• Work cooperatively with PHS providers and personnel to carry out goals and objectives of Outreach and Enrollment.


• Provides leadership for the implementation and coordination of O&E activities such as hosting enrollment events, some after or before normal business hours, evenings and weekends.


• Develop presentations for community groups and referral sources.


• Attend all required training sessions at the federal, state and local level and meetings concerning O&E.


• Safeguard data, maintain strict confidentiality of information, and perform required reporting.


• Accurately complete data collection and enrollment process.


• Conduct "in reach" with currently uninsured PHS patients and "outreach" with non-PHS patients in all service areas.


• Monitor and report all patient correspondence including patient/non-patient completed enrollments.

• Develop relationships with appropriate community partners.


• Provide educational materials regarding insurance options to community partners including health departments, hospitals, urgent cares, physician's offices, and human services agencies and collaborate and coordinate outreach efforts with them.


• Develop a referral tracking system.


• Organize work to meet goals, objectives, and deadlines.


• Multi-task and prioritize duties.


• Develop promotional materials at the appropriate literacy level.


• Other duties assigned by the Director of Quality Operations.


• Ensure all PHSs have timely and necessary information about Ohio's consumer assistance training requirements and the roll-out of new affordable health insurance options.


• Coordinate PHS O/E activities with other consumer assistance efforts in the state.


• Provide technical assistance and training on effective O/E strategies and targeted technical assistance to PHSs experiencing challenges.


• Monitor successes and barriers to PHS O/E activities.


• CACs are expected to provide the following services to consumers, applicants, qualified individuals, enrollees, qualified employees, and qualified employers, and/or these individuals' legal representative(s) or Authorized representatives:


o Provide information about the full range of Qualified Health Plans (QHPs) options and Insurance Affordability Programs for which these persons are eligible

o Assist with applications for coverage in a QHP through the FFE and for Insurance Affordability Programs

o Help to facilitate enrollment in QHPs and Insurance Affordability Programs (p. 1, Agreement between the CMS and CACDO).


• CACs are permitted to create, collect, disclose, access, maintain, store, or use Personally Identifiable Information (PII) from consumers.


• CACs are to access the CAC training hosted by the Medicare Learning Network (MLN), to complete required training and complete all exams to obtain certification.


• CACs must print the certificate of completion and provide it to PHS.


• CACs must submit conflict of interest disclosure forms to PHS's CAC project lead.


• CACs should ensure they have read carefully and signed the CAC agreement with PHS.


• CACs must prominently display their CAC certificate whenever assisting a consumer.


• CACs must maintain a registration process and method to track the performance of CACs.


• CACs are encouraged to provide information and assistance with exemptions and with other health coverage programs, such as drug assistance programs and programs funded under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, but these are not required duties.


• Performs all other duties and tasks as assigned.

Core Competencies

• Customer Service: Committed to increasing customer satisfaction, sets proper customer expectations, assumes responsibility for solving customer problems, ensures commitments to customers are met.

• Communication: Understand and communicate effectively with others using a variety of contexts and formats, which include writing, speaking, reading, listening and interpersonal skills.

• Dependability: Meets commitments, works independently, accepts accountability, handles change, sets personal standards, stays focused under pressure, meets attendance/punctuality requirements.

• Quality: Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems, owns/acts on quality problems.

• Productivity: Manages a fair workload, volunteers for additional work, prioritizes tasks, develops good work procedures, manages time well, and handles information flow.

Success Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience

Bachelor's degree in human services field, or equivalent experience. Experience in planning and implementing projects and coordination of functions, and setting goals and meeting timelines.


Language Skills

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills

To perform this job successfully, an individual should have the ability to gain knowledge of current practice management system, electronic medical record, Microsoft Word, text paging, Internet, and Intranet.

Certificates, Licenses, Registrations

Comply with all applicable federal and state training certificates, licenses, and registrations related to the development of expertise in eligibility, enrollment, and program specifications. Obtain insurance licensure, as required. Valid driver's license, and proof of automobile insurance.


Requirements

Other Applicable Requirements


Skill with geriatric patients and patients in lower socio-economic sectors of the community. Ability to speak Spanish desirable.


Physical Demands

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must regularly lift and /or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee are occasionally exposed to fumes or airborne particles; toxic or caustic chemicals and risk of radiation. The noise level in the work environment is usually moderate.

Affirmative Action/EEO Statement

It is the policy of Primary Health Solutions to provide equal employment opportunities without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, sexual orientation, genetic information or any other protected characteristic under applicable law.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.