Enrollment Specialist

Job Description

Job Description

INTRODUCTION:

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.