Outreach and Enrollment Counselor

Job Description

Job Description

Outreach and Enrollment Counselor

 

 

 

FLSA Classification: Non-exempt 

Reports to: Patient Accounts Receivable Manager 

Origin Date: 07/2013

Revision Date: 8/2026 , 09/2025 , 02/2024

Job Summary/Objective: 

The Outreach and Enrollment Counselor assists uninsured and underinsured patients of PCHC and residents within the PCHC-approved service area with obtaining and maintaining health insurance coverage through Medicaid, HawkI, Marketplace Health Plans, and other available insurance and assistance programs, including applications, renewals, recertifications, and insurance changes. The position also supports community outreach and in-reach efforts to raise awareness of available coverage options. The position works collaboratively with patients, providers, and various clinic departments to reduce barriers to healthcare coverage and ensure accurate insurance information. Performs all defined services and other related duties in accordance with the mission of Peoples Community Health Clinic (PCHC).

Protected Health Information Requirements/Access:

• This position will require the use or disclosure of protected health Information.
• This position will use the Payment class of protected health information.
• Restrictions on the protected health information for this position will follow the Privacy Policies of Peoples Community Health Clinic, Inc.
• Use or disclosure of protected health information not routinely available to this position will follow procedures assessed by or directed by management
• Patient Records – Yes Medical Information System - Yes

 

Essential Functions: 

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• Demonstrates and maintains expertise in affordable insurance options, including Medicaid, HawkI, Marketplace plans, and other available insurance and assistance programs.
• Demonstrates an understanding of the needs of the underserved and vulnerable patient populations.
• Screens uninsured and underinsured patients for available insurance coverage and financial assistance programs.
• Assist patients with applications, renewals, recertifications, insurance changes, and required documentation for Medicaid, HawkI, Marketplace, and other available insurance programs.
• Educates patients regarding insurance options, eligibility requirements, patient responsibilities, and available financial resources.
• Maintains accurate documentation within the electronic health record and other required enrollment systems.
• Collaborates with various clinic departments, providers, and clinical staff to resolve insurance-related issues affecting patient care or reimbursement. 
• Participate in community enrollment events, health fairs, and outreach activities as assigned to promote patient access to healthcare coverage.
• Collaborates with local, regional, and state agencies as needed to support patient enrollment and access to healthcare coverage.
• Assists patients in understanding and addressing health plan coverage issues and eligibility determinations.
• Assists with booking transportation services for patient appointments as needed to support patient access to care.
• Supports a service-oriented atmosphere in accordance with Peoples Community Health Clinic Mission and Philosophy.
• Follows policies and procedures.
• Works to improve work processes and clinical outcomes including health disparity and quality improvement collaborative.
• Develops and maintains own competence including obtaining and maintaining Marketplace Application Counselor Certification (annually) and Iowa Medicaid Presumptive Eligibility Certification (annually).
• Maintains a safe working environment and practices safe working habits.
• Assists in control of Peoples Community Health Clinic resources.

 

Competencies:

• Strong analytical and problem-solving skills
• Strong communication skills, including listening, speaking, writing, basic math, and reading comprehension.

• Skilled in planning, organizing, adaptability, attentiveness to detail and flexibility of assignment.

• Ability to work with diverse groups of people and with a large degree of independence
• Ability to handle multiple tasks simultaneously and to deal with difficult situations 
• Ability to work with and through an interpreter 
• Working knowledge of MS Office Products (ex. Excel, Word, Outlook, Power Point) and Windows Platform. Must be comfortable moving within an EHR system regularly
• Strong interpersonal, customer service, and public relations skills, including the ability to communicate effectively in public settings.
• Ability to maintain confidentiality and handle protected health information in accordance with HIPAA and PCHC policies.
• Ability to learn, interpret, and apply changing insurance eligibility and enrollment requirements.

Supervisory Responsibilities:

• Not applicable

 

Patient Population:

• Pediatric to geriatric patients.

Work Environment/Personal Protective Equipment:

This position operates in a professional office environment and is not required to wear PPE to perform the essential functions of the position.

Physical Demands:

This position requires frequent alternating sitting and standing (34% - 66% of shift); occasional lifting up to 10lbs and carrying up to 20 lbs. (1% - 33% of shift); frequent finger dexterity and use of hands/arms for repetitive movement (34% - 66% of shift); occasional driving, requires 20/40 near and far vision.

Position Type/Expected Hours of Work:

This is a full-time position. Typical work hours and days are between Monday and Friday, 8:00 a.m. to 5:00 p.m. and some flexibility of hours is allowed. Responsibilities occasionally may require irregular hours as deemed necessary. This may include an adjusted work schedule, long days, and early morning or late evening hours to meet client scheduling demands. The employee must work a minimum of 40.0 hours each week to maintain full-time status. 

 

Travel:

Occasional travel and driving are expected for this position.

 

Education and Experience:

• High School Diploma or GED required.
• Minimum of one year of experience in a medical office, healthcare, insurance enrollment, patient financial services, customer service, or a related field required. Experience working with Medicare, Medicaid, Marketplace, or commercial insurance plans.

 

Licensure:

• Valid driver’s license and auto liability coverage required

Certification:

• Certified Application Counselor (CAC) certification preferred or must be obtained[LD1] within 90 days of hire.
• Iowa Medicaid Presumptive Provider Certification must be obtained within 90 days of hire.

 

 

Other Duties:

The statements contained in this job description reflect general details as necessary to describe the principal functions of this job, the level of knowledge and skill typically required, and the scope of responsibility. It should not be considered an all-inclusive listing of work requirements as individuals may perform other duties as assigned. 

[LD1]What is the timeframe for obtaining these certifications? We would want to include that in the description.