Enrollment Specialist

The purpose of the Health Advocate is to work within the communities we serve, to identify community leadership and community members who are eligible for County Health programs, State programs such as Medi-Cal and Covered CA (Affordable Care Act), provide all program insurance information, assist in filling out applications for the members of the community and assist prospects in enrolling for these health insurance programs. The Health Advocate will also help empower individuals to overcome enrollment problems for all county and state programs such as Medi-Cal and Covered CA, and health access barriers. The Health Advocate will conduct outreach and in-reach efforts to current and potential members of QueensCare Health Centers. The Health Advocate functions as a community organizer, health insurance "broker", by identifying appropriate health coverage that the prospect qualifies for, promotes health insurance utilization and retention and helps recruit new members to the QueensCare Health Centers.


ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Support and implement the organizations vision, mission and values 2. Determines priorities and method of completing daily workload to complete responsibilities in a timely manner. 3. Performs all job functions in a professional and courteous manner. This includes answering all phone calls and emails timely and providing excellent customer service to internal and external customers. 4. Maintain expertise in eligibility, enrollment and program specifics for all county and state programs such as, Covered CA and Medi-Cal and all programs accessible to our community. 5. Provide information in a fair, accurate and impartial manner. 6. Develop and maintain updated information to help understand the composition of the communities in the service area, including the primary languages spoken. 7. For Covered CA, the Certified Enrollment Counselor (CEC) must wear the Covered CA assigned badge when enrolling or disseminating information regarding Covered CA. 8. Fosters and promotes a culture of service excellence and accountability. 9. Assist eligible families with completing and submitting the appropriate health insurance application/s, including assistance with gathering necessary documents and resolving problems. 10. Process applications using Health-E-APP, One-E-APP, CALHEERS or other web-based programs. 11. Conduct client to perform intakes by phone and in person to determine their immediate healthcare needs and connected them to the proper resources. 12. Provide support and education to assist families when a problem with health coverage arises. May act as family liaison with various health coverage programs. 13. Provide education and information to families about utilization of health coverage, plan benefits, and maintaining coverage.
14. Promote awareness and access to healthcare through no-cost/low-cost health coverage programs 15. Review applications for completeness and accuracy to include paper and/or electronic applications for county and state programs such as Medi-Cal or Covered CA. 16. Maintain CEC certification to access the CALHEERS and Covered CA web sites for enrollment purposes 17. Assist with health education and outreach opportunities in the community such as health fairs, presentations, and special events as needed. 18. Demonstrate ability and flexibility to work in other areas and/or locations of the organization as needed. 19. Track all applications and help families with appeals when appropriate 20. Contact families at the time their annual renewal is due to offer re-enrollment assistance. 21. Contact potential leads identified at Outreach Events (Health Fairs, Resource Fairs, etc.) to schedule enrollment appointments 22. Conduct in-reach by contacting families associated with QueensCare Health Centers as needed. 23. Refer families to appropriate community programs according to each family's needs. 24. Attend monthly training meetings, and other periodic trainings to retain the most current understanding of enrollment programs. 25. Maintain the most current and up-to-date knowledge of Health Plans, Health Insurance(s), Program Eligibility, Medi-Cal updates, Medi-Care updates, Federal/State/County programs updates and all other health programs available to current and prospective patients of QHC. 26. Complete data tracking, monthly reports and client file-related paperwork on a routine basis. 27. Perform outbound calls to members aging into Medi-Care 28. Perform outbound calls to members due for redetermination of health coverage. 29. Assist patients with MyChart registration. 30. Complies with organizational policies and procedures. 31. Perform all other duties as assigned.

QUALIFICATIONS: 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 ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE: High School diploma or equivalency certificate required. Ability to learn about and understand state and county programs such as Medi-Cal, Covered CA (Affordable Care act) and other health insurance programs required. A valid CEC certification, requiring annual renewal (QHC will sponsor upon hiring) Successfully pass the Live Scan background check for a CEC. Sales/Marketing and public speaking and presentation experience preferred.

LANGUAGE SKILLS: Ability to read and interpret documents, such as policies and procedures, benefits information, benefit surveys, board minutes, routine mail, simple contracts, and procedure manuals. Ability to compose routine reports and correspondence. Ability to speak effectively with employees, visitors and management.

MATHEMATICAL SKILLS: Ability to calculate figures and basic math.

REASONING ABILITY: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to
apply common sense to daily situations that arise. Ability to make decisions and execute to produce a positive outcome.

OTHER SKILLS AND ABILITIES: Exercise good judgment. Ability to identify and access appropriate community resources and work with of community leaders. Familiarity with multicultural settings and sensitivity to multicultural issues. Self-starter, able to take initiative and provide input for decision-making. Computer literate.

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 regularly required to use hands to finger, handle or feel and reach with hands and arms. The employee frequently is required to stand, walk, and sit. The employee is occasionally required to climb or balance, stoop, kneel, crouch or sit. The employee must frequently lift and/or move up to 10 pounds and occasionally life and/or move up to 30 pounds. The employee is occasionally required to ascend and descend one flight of stairs. Specific vision abilities required by the job include close vision, color vision, 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.

The noise level in the work environment is often low. However, there are many times when there is a high ambient background noise of phones and multiple conversations. Must be able to screen out the background noise to concentrate on the work at hand.

QUALIFICATIONS:

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

EDUCATION/EXPERIENCE:

High School diploma or equivalency certificate required.


Ability to learn about and understand state and county programs such as Medi-Cal, Covered CA (Affordable Care act) and other health insurance programs required.


A valid CEC certification, requiring annual renewal (QHC will sponsor upon hiring)

Successfully pass the Live Scan background check for a CEC.


Sales/Marketing and public speaking and presentation experience preferred.


LANGUAGE SKILLS:

Ability to read and interpret documents, such as policies and procedures, benefits information, benefit surveys, board minutes, routine mail, simple contracts, and procedure manuals. Ability to compose routine reports and correspondence. Ability to speak effectively with employees, visitors and management.

MATHEMATICAL SKILLS:

Ability to calculate figures and basic math.

REASONING ABILITY:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to apply common sense to daily situations that arise. Ability to make decisions and execute to produce a positive outcome.

OTHER SKILLS AND ABILITIES:

Exercise good judgment.

Ability to identify and access appropriate community resources and work with of community leaders.


Familiarity with multicultural settings and sensitivity to multicultural issues.

Self-starter, able to take initiative and provide input for decision-making.


Computer literate.

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 regularly required to use hands to finger, handle or feel and reach with hands and arms. The employee frequently is required to stand, walk, and sit. The employee is occasionally required to climb or balance, stoop, kneel, crouch or sit. The employee must frequently lift and/or move up to 10 pounds and occasionally life and/or move up to 30 pounds. The employee is occasionally required to ascend and descend one flight of stairs. Specific vision abilities required by the job include close vision, color vision, 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.

The noise level in the work environment is often low. However, there are many times when there is a high ambient background noise of phones and multiple conversations. Must be able to screen out the background noise to concentrate on the work at hand.