Enrollment Specialist

Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center committed to the Triple Aim as described by the Institute for Healthcare Improvement. Improving the US Health Care System requires simultaneous pursuit of three aims: 1) improving the experience of care, 2) improving the health of populations and 3) reducing per capita costs of health care. Preconditions for this include the enrollment of an identified population, a commitment to universality for its members, and the existence of an organization (an "integrator") that accepts responsibility for all three aims for that population.

SUMMARY:

The Enrollment Specialist assists patients with health insurance enrollment, Medi-Cal renewal and retention, CalFresh applications, and information regarding insurance plans accepted at the clinic. This position supports patients in obtaining and maintaining continuous health coverage through enrollment assistance, proactive outreach, renewal support, and follow-up services. Responsibilities include providing guidance on enrollment and renewal requirements, working assigned termination and renewal lists, conducting telephone outreach to patients at risk of losing Medi-Cal coverage, obtaining missing application information and supporting documentation, and identifying and addressing barriers to continued coverage. The Enrollment Specialist ensures patient information is accurately entered and maintained in the Electronic Health Record (EHR) system and works to reduce coverage lapses to help patients maintain access to healthcare services. The Enrollment Specialist must possess the required qualifications or be willing to complete the necessary training and certification to assist patients with health insurance enrollment and retention.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Enrollment, Education, and Patient Assistance

Provides patients with educational information on managed care, both in the clinic and in the community, through formal and informal interactions.

Screens patients to determine enrollment eligibility and schedules appointments for initial enrollment.

Enrolls patients in Covered California health insurance plans.

Reviews and works assigned Medi-Cal termination and renewal lists to identify patients at risk of losing coverage and prioritize outreach based on upcoming renewal deadlines or potential termination.

Conducts proactive outbound telephone outreach to patients whose Medi-Cal coverage is approaching termination or has already been discontinued, reminding them of renewal deadlines and explaining the importance of completing renewal requirements on time.

Maintains and follows up on retention lists by contacting cash-paying patients and disenrolled members to assess eligibility, identify reasons for disenrollment, and assist with re-enrollment when appropriate.

Assists patients with CalFresh applications and renewals, including completion of required Semi-Annual Reports (SAR 7).

Assists patients with completing and submitting Health Care Options and Medi-Cal health plan selection forms.

Contacts health plans to request Primary Care Physician (PCP) changes on behalf of patients.

Educates and advises patients on available health insurance coverage options and health plans.

Assists patients in accessing transportation benefits through their health insurance plans and obtaining interpretation or translation services as needed.

Conducts outreach activities to increase patient enrollment and expand the clinic's patient roster.

Assists patients with identifying and accessing available community resources, including housing and employment assistance, based on their individual needs.

Assists eligible patients with the Los Angeles County General Relief (GR) program by providing information, helping navigate application requirements, and assisting with applications and required documentation, as appropriate.

Medi-Cal Retention and Renewal Assistance

Assists patients by telephone with understanding Medi-Cal renewal notices, eligibility requirements, reporting obligations, deadlines, and required supporting documentation.

Guides patients through BenefitsCal to review renewal information and submit required documentation, as appropriate.

Assists patients with contacting the Los Angeles County Department of Public Social Services (DPSS) regarding pending renewals, missing documentation, and eligibility-related questions.

Educates patients on the importance of keeping their contact information current with DPSS to help ensure they receive renewal notices and other important communications.

Identifies patients who need assistance maintaining or restoring Medi-Cal coverage and explains available reinstatement or reapplication options when coverage has been discontinued.

Conducts timely follow-up with patients regarding outstanding renewal requirements, missing documentation, and unresolved coverage issues until the renewal status is resolved or the case is appropriately referred to the relevant department or agency.

Coordinates with patients and appropriate enrollment personnel to facilitate continued coverage and reduce preventable gaps in Medi-Cal enrollment.

Eligibility Verification and Coordination

Verifies Medi-Cal eligibility and coverage status using authorized systems and established procedures.

Reviews available eligibility information, renewal dates, and termination notices to identify potential interruptions in coverage and determine appropriate follow-up actions.

Identifies cases requiring additional documentation, eligibility clarification, or intervention from DPSS or other appropriate agencies.

Refers patients to DPSS or the appropriate enrollment personnel when additional assistance or resolution is required beyond the scope of the position.

Follows established procedures when communicating eligibility information and coordinating referrals to support accurate information sharing and continuity of patient care.

Documentation, Reporting, and Performance

Submits weekly reports documenting completed enrollments.

Documents patient outreach attempts, telephone communications, enrollment and renewal assistance, referrals, and follow-up activities accurately and promptly.

Maintains accurate and up-to-date records in the designated retention tracking system and applicable Electronic Health Record (EHR) systems.

Updates retention tracking records to reflect patient outcomes, including completed renewals, pending cases, unresolved issues, and discontinued coverage.

Submits daily productivity reports to the Certified Enrollment Manager in accordance with departmental procedures.

Monitors assigned retention cases and identifies patients requiring additional outreach, documentation, or assistance.

Meets departmental outreach, documentation, and productivity goals established by the Certified Enrollment Manager.

Communicates unresolved cases and barriers to successful enrollment or retention to the appropriate supervisor or department in a timely manner.

Contributes to reducing preventable Medi-Cal coverage losses and supporting continuity of patient access to healthcare services.

Performs other related duties as assigned.

QUALIFICATION REQUIREMENTS:

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

EDUCATION AND/OR EXPERIENCE:

High School Diploma or equivalent.

CAA (Certified Application Assistor) Certification required. If the incumbent does not have current CAA certification, it must be obtained within six months of hire.

One year of experience in a medical office or a related healthcare or patient enrollment setting is preferred.

CPR Certification preferred.

Experience in healthcare enrollment, Medi-Cal eligibility and renewals, patient outreach, customer service, or a related field is preferred.

Experience assisting patients with public health insurance programs or navigating government benefits systems is preferred.

Experience with telephone outreach, case follow-up, data entry, or maintaining tracking lists is preferred.

NECESSARY SKILLS:

Ability to communicate effectively, both verbally and in writing, with patients, the public, medical staff, and physicians.

Must hold or be willing to obtain the required certification to assist patients with health insurance enrollment within the designated timeframe.

Knowledge of Electronic Health Record (EHR) systems and accurate patient data entry.

Knowledge of health insurance programs, coverage options, and enrollment processes, including Covered California and Medi-Cal.

Familiarity with CalFresh and General Relief (GR) programs and their application requirements, or the ability to learn applicable program requirements.

Excellent organizational skills and attention to detail.

Ability to work independently and demonstrate effective time management, prioritization, and follow-up skills.

Ability to maintain patient confidentiality and handle sensitive personal information appropriately.

Ability to provide clear information to patients, assist with application documentation, and connect patients with appropriate community resources.

Knowledge of Medi-Cal coverage, renewal processes, eligibility requirements, and common reasons for coverage termination, or the ability to learn these requirements.

Familiarity with the Los Angeles County Department of Public Social Services (DPSS), BenefitsCal, and Medi-Cal eligibility verification systems is preferred.

Strong telephone communication and patient service skills, including the ability to explain renewal requirements clearly and assist patients in navigating the renewal process.

Ability to conduct proactive outreach, manage assigned termination and renewal lists, prioritize time-sensitive cases, and complete timely follow-up.

Strong organizational and case management skills, with the ability to manage multiple cases while meeting established productivity expectations.

Basic computer skills, including data entry, electronic recordkeeping, and the use of tracking systems.

Ability to document patient interactions, maintain accurate records, and prepare routine productivity reports.

Ability to identify barriers to Medi-Cal retention and refer patients to the appropriate agency, department, or resource when additional assistance is needed.

Ability to work collaboratively with the Enrollment team, Enrollment Manager, and other relevant departments while independently managing assigned responsibilities.

Ability to maintain patient confidentiality and comply with HIPAA requirements and applicable organizational privacy and security policies.

Bilingual English/Spanish skills preferred.

Policy

Punctual and regular attendance is an essential responsibility of each employee at CNHF. Employees are expected to report to work as scheduled, on time and prepared to start working. Employees also are expected to remain at work for their entire work schedule. Late arrival, early departure or other absences from scheduled hours are disruptive and must be avoided.

This policy does not apply to absences covered by the Family and Medical Leave Act (FMLA) or leave provided as a reasonable accommodation under the Americans with Disabilities Act (ADA). These exceptions are described in separate policies.

WORK ENVIRONMENT

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 qualified individuals with disabilities to perform the essential functions. Variations in conditions may occur under certain circumstances.

CONFIDENTIALITY

Maintains patient, employee, and Foundation confidentiality at all times, discussing patient or employee business only with appropriate parties who have a bona fide need to know; and communicating only the minimum amount of information necessary with respect to protected health information (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

AGREEMENT AND ACCEPTANCE