Certified Application Counselor

Certified Application Counselor

The Certified Application Counselor – Medicaid Recertification Specialist serves as a healthcare professional responsible for comprehensive care coordination combined with a specialized focus on Medicaid recertification and continuity of coverage. This role is a vital link between patients and their health insurance, ensuring that Medicaid-eligible and enrolled patients complete timely renewals, maintain uninterrupted coverage, and meet evolving eligibility requirements. The Counselor manages both the clinical-adjacent and administrative aspects of enrollment across NYREACH's community-based programs and clinical partner sites in the Bronx, with particular attention to patients navigating six-month renewal cycles and community engagement documentation requirements.

Key responsibilities include:

• Recertification & renewal assistance: Conduct Medicaid recertification and renewal assistance for enrolled and transitioning patients, proactively guiding them through renewal cycles — including six-month renewal requirements under H.R. 1 (effective January 2027) — to prevent avoidable gaps in coverage.
• Eligibility screening & outreach: Perform insurance status screening; identify eligibility gaps, program mismatches, and patients approaching renewal deadlines; and conduct outbound outreach to at-risk patients before coverage lapses.
• Application & renewal processing: Complete and submit new applications and renewals through the NY State of Health (NYSOH) enrollment portal, collecting, organizing, and uploading all required documentation at the time of application to ensure complete, high-quality submissions.
• Coverage counseling: Counsel patients on the differences between Medicaid, Essential Plan, and Qualified Health Plans (QHPs), as well as out-of-pocket costs, metal tiers, tax credits (APTC), and the appeals/complaint process — acting as a neutral party in health plan selection.
• Community Engagement documentation: Support patients in meeting and documenting H.R. 1 Community Engagement requirements (the 80-hour annual work/volunteer requirement), and identify and document applicable exemptions (e.g., medically frail, caregiver of a dependent child under 13, American Indian/Alaska Native, former foster youth).
• Complex-household support: Assist patients in mixed-status and undocumented households, addressing public charge concerns and connecting eligible household members to appropriate coverage.
• Scheduling & follow-up: Manage appointment scheduling and reminder protocols (text/call reminders), maintain appointment availability within established timeframes, and minimize no-shows through consistent follow-up.
• Referrals: Provide same-day appeal referrals and same-day referrals to the Local Department of Social Services (LDSS) for non-MAGI applicants.
• Documentation & compliance: Maintain accurate, timely documentation in NYSOH and the EHR to support continuity of care and compliant reporting; handle Personally Identifiable Information (PII) in compliance with HIPAA and 45 CFR §155.260; and adhere to Navigator/Assistor conflict-of-interest standards.
• Productivity & quality standards: Meet monthly application and renewal targets and quality benchmarks (e.g., application completion rate, documentation-upload rate at submission, and no-show rate), with performance monitored through program dashboards.
• Small business & SHOP support (as assigned): Provide one-on-one SHOP enrollment assistance to eligible small employers and educate them on the federal Small Business Health Care Tax Credit.

Required degree and certifications:

Associate's degree.

NY State of Health (NYSOH) Assistor/Navigator Certification — obtained within the first weeks of hire; must pass the NYSOH Assistor Certification exam (80%+) before any client contact. Candidates with prior certification strongly preferred; otherwise, ability and willingness to obtain certification within 30 days of hire is required.

Relevant certifications in healthcare, social services, or care management are considered (Certified Application Counselor (CAC), CPHQ, CCM, or similar credentials).

Preferred experience:

1–2 years of direct experience with Medicaid enrollment, recertification, eligibility determination, care coordination, or case management in healthcare.

Experience navigating the NY State of Health Marketplace and/or Certified Application Counselor / Navigator work.

Experience with HRSN screening, Social Care Network (SCN) programs, or similar systems-navigation work.

Knowledge of Medicaid, Medicare, Essential Plan, QHPs, managed care, and health insurance processes.

Familiarity with MAGI vs. non-MAGI eligibility, Medicaid spenddown, and APTC reconciliation.

Comfortable being on the phone throughout the day with high outreach and follow-up volume.

Familiarity with Electronic Health Records (EHR) systems, preferably eCW.

Previous experience in outreach, community engagement, enrollment, or social services.

Understanding of HIPAA regulations, 45 CFR §155.260, and patient privacy requirements.

Skills & competencies:

Bilingual: Fluent in Spanish and English (Preferred).

Excellent communication skills with the ability to explain complex eligibility and coverage information clearly and impartially.

Strong interpersonal skills with the ability to build rapport and trust with diverse patient populations.

Proficiency in motivational interviewing and health coaching techniques.

Training in (or ability to be trained in) trauma-informed care and cultural humility for work with undocumented, elderly, and high-need residents.

Ability to work independently and collaboratively as part of an integrated care team.

Strong organizational and time-management skills with the ability to manage multiple renewal deadlines and priorities.

Cultural sensitivity and ability to work with diverse, underserved populations.

Proficiency in Microsoft Office suite including Teams, Excel, Outlook, and Word.

Problem-solving skills and ability to navigate complex healthcare and eligibility systems.

Attention to detail with strong documentation skills.

Ability to maintain confidentiality and professional boundaries.

Flexibility and adaptability in a fast-paced healthcare environment, including some evening and weekend availability to reach working patients.

Compensation & benefits:

Pay: $20.00 – $22.00 per hour

Job Type: Full-time

Comprehensive benefits package

Professional development opportunities

Supportive team environment

Equal Opportunity Employer

NYREACH is an equal opportunity employer committed to diversity and inclusion in the workplace.