Enrollment Specialist

Job Description

Job Description

INTRODUCTION:

Central Neighborhood Health Foundation is a Federally Qualified Healthcare Center (FQHC) 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 provides enrollment assistance and patient navigation services, including screening patients for eligibility, assisting with health coverage applications, completing renewals, resolving enrollment issues, and educating patients on available healthcare options. Also assisting patients with Medi-Cal, Covered California, CalFresh, General Relief (GR), managed care plans, PCP transfers, IPA transfers, and other healthcare access needs. They are responsible for accurately collecting, verifying, documenting, and entering patient information into the Electronic Health Record (EHR)/IMS system while maintaining compliance with HIPAA regulations and organizational standards.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Screen patients to determine eligibility for healthcare coverage and assistance programs.

• Assist patients with Medi-Cal applications, renewals, and troubleshooting inactive coverage.

• Assist patients with Covered California applications and health plan selection.

• Assist patients with CalFresh applications and 6-month renewal requirements (SAR 7).

• Assist patients with General Relief (GR) applications and available resources.

• Educate patients regarding managed care plans, health insurance benefits, and available healthcare options.

• Assist patients with Health Care Options and Medi-Cal Choice forms.

• Process Primary Care Physician (PCP) transfers and updates.

• Assist with IPA transfers and healthcare plan changes.

• Conduct follow-up outreach to patients regarding missing documentation, enrollment applications, renewals, and retention efforts.

• Assist patients with transportation benefits and translation service resources available through health plans.

• Provide education regarding the clinic’s accepted insurance plans and enrollment requirements.

• Assist uninsured and underinsured patients with available resources, including sliding fee discount program information.

• Review and update patient demographic, insurance, and eligibility information in the IMS/EHR system.

• Ensure accurate registration and documentation of patient information.

• Conduct outreach activities to increase patient access and support patient retention.

• Maintain productivity documentation, reports, and enrollment tracking.

• Assist patients with community resources related to housing, employment, and other social needs.

• Collaborate with clinic teams to ensure patients receive appropriate access to care.

• Participate in trainings, meetings, and quality improvement activities.

• Perform 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 required.

• Certified Application Assistor (CAA) certification required.

• Certified Enrollment Counselor certification required or willingness to obtain certification.

• Employees hired without current certification must obtain required certification within six months of hire or within the timeframe established by the organization.

• One year of experience in medical office operations, healthcare enrollment, patient registration, or related field preferred.

• Bilingual Spanish speaking preferred.

NECESSARY SKILLS:

• Ability to communicate effectively in both written and verbal form to patients, public, medical staff, and physicians.

• Knowledge of Medi-Cal, Covered California, CalFresh, managed care plans, and healthcare enrollment processes.

• Knowledge of Electronic Health Records and patient registration systems.

• Ability to communicate effectively with patients, providers, and healthcare staff.

• Strong organizational skills and attention to detail.

• Ability to manage multiple priorities and meet deadlines.

• Ability to maintain confidentiality and follow HIPAA requirements.

• Ability to provide culturally competent service to diverse patient populations.

• Ability to work independently and as part of a team.

• Excellent organizational skills and attention to detail.

• Ability to work independently and possess strong time management skills

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).

1. AGREEMENT AND ACCEPTANCE

2. I HAVE READ THE ABOVE JOB DESCRIPTION AND FULLY UNDERSTAND THE REQUIREMENTS SET FORTH AND WILL PERFORM ALL DUTIES AND RESPONSIBILITIES TO THE BEST OF MY ABILITY.