Managed Care Enrollment Coordinator

Managed Care Enrollment Coordinator

Under the direct supervision of the Director of Managed Care Services, the Managed Care Enrollment Coordinator is responsible for implementing patient enabling services, including member's enrollment into Managed Care Plans (MCPs), selection of Primary Care Physicians (PCPs), transfers of MCPs and PCPs, eligibility verification, as well as health care coverage navigation and orientation. The Managed Care Enrollment Coordinator provides outreach and engagement to schedule Initial Health Assessments for new enrollees and surveys disenrolled patients to implement coverage and retention strategies. The Managed Care Enrollment Coordinator validates and prepares monthly eligibility reports from the contracted Independent Physician Association (IPA) and MCPs, detailing monthly enrollment, disenrollment, as well as new membership outreach and engagement activities, patient assistance and other duties as assigned.

Duties and Responsibilities:

1. Responsible for providing enabling and navigation services to enrollees and eligible patients into Managed Care, following the Managed Care Enrollment Handbook guidelines and related organization policy and procedures. Provides proactive feedback to ensure departmental compliance with MCP and regulatory agencies.
2. Responsible for assisting eligible Medi-Cal, Medicare Advantage and Covered CA patients with enrolling into health plan coverage. Responsible for assisting patients and their families with plan and provider transfers and maintaining data about those assisted. Coordinates with contracted MCP and/or Medicare Agents for enrollment support as needed.
3. Responsible for scheduling appointments or assist walk-in Managed Care eligible patients with enrollment applications utilizing the Covered CA and BenefitsCal platforms.
4. Responsible for assisting patients as needed to retain active coverage status under a Managed Care Plan, including Medi-Cal annual redetermination, as well as providing support for Covered CA and Medicare annual renewal and open enrollment period. Fully utilizes the EHR, IPA and/or MCP platform to verify and validate patient eligibility and coverage,
5. Responsible for initiating solutions when a Managed Care coverage problem arises for patients seeking to access services at Arroyo Vista. Responsible for providing patients with information and orientation on Medi-Cal, Medicare and Covered CA Managed Care options and enrollment process.
6. Responsible for completing and documenting at least three (3) outreach attempts to maximize compliance with DHCS and MCP's Initial Health Assessments (IHA) guidelines. Schedule IHA appointments for new patients within 120 days of enrollment, survey and follow up on show rates for IHA compliance within the Electronic Health Record (EHR)'s Payer Enrollment Manager (PEM) system and department daily logs.
7. Responsible for surveying disenrolled (termed) members, and provides assistance with re-enrollment as applicable, or requests for Medi-Cal Exemptions when necessary, per patient's choice. Maintains data on survey findings and patient assistance.
8. Responsible for referring patients to the Department of Public Social Services (DPSS) Worker(s) as needed. Provide support with case escalation and resolution with DPSS.
9. Responsible for documenting and adding alerts in the EMR Practice Management system for Managed Care PCP and Plan transfers and other Managed Care eligibility related notes.
10. Responsible for following-up on courtesy visits of Managed Care patients to ensure completion of transfer.
11. Responsible for maintaining efficient flow of Managed Care patients. Responsible for handling telephone calls to and from patients, health plans, IPA and Health Care Options regarding managed care issues, in a timely and effective manner, and logging information on telephone interactions. Responsible for receiving patients and public in a professional and courteous manner. Responsible for communicating concerns and seek solutions when necessary to the appropriate staff members or departments.
12. Responsible for following agency safety and health standards, regulations, procedures, policies, and practices. Actively participates in the Quality Management Program, Safety Program, Emergency Preparedness and Infection Control Programs. Responsible for attending trainings and seminars regarding relevant outreach, enrollment and retention strategies for Managed Care plans accepted at Arroyo Vista.
13. Responsible to take such steps necessary to allow Arroyo Vista to realize the benefits of the Electronic Health Records system including the adoption, implementation, upgrading and meaningful use of such technology as requested or required by Arroyo Vista or other federal or state authority.
14. Performs other duties as assigned.

Requirements:

1. Associates Degree and one year Managed Care Enrollment related experience, or 2 or more years of experience in the health care field. Experience in Managed Care Enrollment, Medical Front/Back Office and/or Financial Screening preferred. Two years of experience with customer service and satisfactory written, telephone, and verbal communication skills.
2. Complete Certified Application Assistant (CAA) Covered CA certification, within first month of hire.
3. Bilingual (English/Spanish).
4. Computer literate in health information system(s) and Microsoft Office applications with ability to type 35 WPM.
5. Effective verbal and written communication skills with ability to be thorough, accurate, and detail oriented.
6. Reliable transportation with the ability to get to other locations as required to perform the functions of the position.
7. Ability to work well with others in a professional team oriented environment.

Arroyo Vista Family Health Center