Member Services Enrollment Coordinator

Job Description

Job Description

Under the supervision of the Member Services Manager, the Member Services Enrollment Coordinator works with patients, and community members to provide education and assistance related to enrollment in Medicaid, Children’s Health Insurance Program (CHIP), and/or the Health Insurance Marketplace. Supports enrollment and eligibility across all health programs (i.e. primary care, dental, behavioral health, etc.). Maintains high data entry standards for PITU Member Services, including assisting with enrollment and eligibility while serving as a back-up to process authorizations for qualifying members of the PITU Member Services Programs. Adheres to strict privacy policies protecting patient/client information.

Work Schedule:

Monday - Friday

8:00 AM - 5:00 PM

1-Hour Lunch Break (Unpaid)

Job Functions:

Include, but not limited to the following:

1. Provides information to Health Staff regarding the coordination, education, and assistance of individuals with enrolling into Medicaid, CHIP, Health Insurance Exchange, Food Stamps, and Child Care monthly. This includes traveling within the service area to meet one-on-one with clients and acting as a liaison between the individual and the State as needed.
2. Contacts patients, within three days of a referral, who do not have coverage or are not eligible for Purchased Referred Care (PRC). Provides follow-up efforts on submitted and pending cases that are outstanding and documents any incomplete applications.
3. Works closely with clients, PITU Purchased Referred Care (PRC) program and the State “MyCase” program (as a third-party access provider) to ensure ongoing eligibility of benefits; this includes assisting clients with annual Medicaid review process.
4. Works as an advocate for Tribal Members.
5. Coordinates with department managers and patient care to ensure consistent communication occurs.
6. Provides training when needed to Clinic Receptionists and other support staff (primary care, dental, behavioral health) on entering data into the Electronic Health Record including updating eligibility, entering and correctly sequencing insurance information, adding and updating patient assignment of benefits.
7. Performs weekly audit of PRC health center (medical, dental, and behavioral health) appointments to ensure patient registration, eligibility and insurance is being captured and input into the system correctly.
8. Keeps supervisor informed about work progress through weekly reports that include statistics on the number of individuals assisted present and potential work problems and new/innovative suggestions on overcoming potential barriers.
9. Reviews patients under 18 and over 65 reports quarterly and contacts all patients/guardians to enroll patients in alternate resources.
10. Reviews and approves or denies sliding fee applications and ensures proper documentation is uploaded to EHR.
11. Attends meetings, conferences, workshops, and training sessions to remain current on new developments that may impact patient benefits.
12. Responds to requests and questions in a courteous and timely manner.
13. Verifies the mailing address of Tribal Members annually and assures the system is updated if information changes.
14. Reminds Tribal Members to apply for alternate resources within the time frame allowed by policy to be PRC eligible, and reports to supervisor when tribal members have not followed through with the application process.
15. Provides backup support for receptionists when needed.
16. Provides backup support to process authorizations.
17. Other duties as assigned to support the efficient operations of the Tribe.

Necessary Knowledge, Skills, & Abilities:

• Knowledge of Medicaid, CHIP, and Medicare programs.
• Exceptional flexibility and positive people skills. 
• Willingness to learn new tools and technologies. 
• Maintains a positive attitude. 
• Comfortable working under tight deadlines. 
• Ability to establish and maintain effective working relationships with all levels of the organization and community. 
• Ability to manage and perform with a high degree of autonomy, organization, and adaptability. 
• Must be able to demonstrate respect for and awareness of Native American customs, traditions, and socioeconomic needs. 
• Must have excellent oral and written communication skills, including public speaking with large and small groups of different managerial, socioeconomic, cultural, ethnic, and educational backgrounds. 
• Must be willing to travel weekly. 
• Must have knowledge of health insurance terms and enrollment processes.

Requirements

General Requirements:

• Must be insurable through the Tribe’s vehicle insurance required.
• Must pass a criminal and fingerprint background check according to P.L. 101-630 standards required.
• Must pass a pre-employment alcohol/drug screening required.

Education & Experience:

• High School diploma, equivalent GED or higher required.
• One (1) year experience in working in a health-related field required.
• Preferred one (1) year experience with insurance enrollment including Medicaid, CHIP, Marketplace.

License & Certification:

• Must possess, maintain, and provide proof of a valid Driver License required.
• Must obtain, maintain, and provide proof of a valid Certified Application Counselor Training certification within one (1) month of hire date required.

Benefits

• Group Health Care Plan (Health, Dental, Vision, Life/AD&D and Long-Term Disability). Employer paid premiums for Employee, Spouse and Dependents
• Supplemental/Voluntary Benefits (Life/AD&D and Short-Term Disability, Hospital Indemnity, Accident, Critical Illness)
• HSA Bank Account - Monthly employer contributions
• Retirement Plan (401k, Roth) - Dollar for dollar match up to 6%
• Paid Time Off (PTO)
• Paid Holidays (Federal, State and Tribal) - Paid according to set work schedule only
• Paid Birthday Leave
• Paid Bereavement Leave
• Employee Assistance Program
• Education Assistance Program
• Wellness Program - Earn up to $1,000 into your HSA account per year