Certified Application Counselor

Essen Medical Associates•Bronx, NY

18d

About The Position

The Certified Application Counselor – Medicaid Recertification Specialist provides comprehensive care coordination and specializes in Medicaid recertification and continuity of coverage. The role helps Medicaid-eligible and enrolled patients complete timely renewals, maintain uninterrupted coverage, and meet changing eligibility requirements. The Counselor manages enrollment-related clinical-adjacent and administrative work across NYREACH community programs and clinical partner sites in the Bronx, with particular attention to six-month renewal cycles and community engagement documentation requirements. The position also provides care management for patients with multiple chronic conditions through Health Home, Health Home Plus, HARP, and related programs. The Counselor screens for insurance status and eligibility needs, completes applications and renewals through the NY State of Health portal, counsels patients about coverage options, supports community engagement documentation, and coordinates referrals and follow-up. The role requires accurate documentation and privacy-compliant handling of patient information, as well as meeting monthly application and renewal targets and quality benchmarks. Small business SHOP enrollment assistance may also be assigned.

Requirements

Associate’s degree.
Obtain NY State of Health Assistor/Navigator Certification within the first weeks of hire and pass the certification exam with a score of at least 80% before any client contact; candidates without prior certification must be willing and able to obtain it within 30 days of hire.
Excellent communication skills and ability to explain complex eligibility and coverage information clearly and impartially.
Strong interpersonal skills and ability to build rapport and trust with diverse patient populations.

Nice To Haves

Prior NY State of Health Assistor/Navigator certification.
Relevant healthcare, social services, or care management credentials such as Certified Application Counselor (CAC), CPHQ, or CCM.
1–2 years of direct experience with Medicaid enrollment, recertification, eligibility determination, care coordination, or healthcare case management.
Experience navigating the NY State of Health Marketplace or working as a Certified Application Counselor or Navigator.
Experience with HRSN screening, Social Care Network programs, or similar systems-navigation work.
Knowledge of Medicaid, Medicare, Essential Plan, Qualified Health Plans, managed care, and health insurance processes.
Familiarity with MAGI and non-MAGI eligibility, Medicaid spenddown, and APTC reconciliation.
Comfort with frequent phone outreach and follow-up throughout the day.
Familiarity with Electronic Health Records, preferably eCW.
Previous experience in outreach, community engagement, enrollment, or social services.
Understanding of HIPAA, 45 CFR §155.260, and patient privacy requirements.
Fluency in Spanish and English.

Responsibilities

Provide comprehensive care management for patients with multiple chronic conditions through Health Home, Health Home Plus, HARP, and related programs, coordinating services across NYREACH’s clinical and community partner network.
Assist enrolled and transitioning patients with Medicaid recertification and renewals, including six-month renewal requirements, to help prevent gaps in coverage.
Screen insurance status, identify eligibility gaps and program mismatches, identify patients approaching renewal deadlines, and conduct proactive outreach.
Complete and submit new applications and renewals through the NY State of Health enrollment portal; collect, organize, and upload required documentation.
Explain Medicaid, Essential Plan, and Qualified Health Plan options, out-of-pocket costs, metal tiers, tax credits, and appeals and complaints processes impartially.
Help patients meet and document Community Engagement requirements and identify and document applicable exemptions.
Assist mixed-status and undocumented households, address public charge concerns, and connect eligible household members to appropriate coverage.
Manage appointment scheduling, text and call reminders, appointment availability, and follow-up to reduce no-shows.
Provide same-day appeal referrals and same-day referrals to the Local Department of Social Services for non-MAGI applicants.
Maintain accurate and timely documentation in NYSOH and the EHR, comply with privacy requirements, and follow Navigator/Assistor conflict-of-interest standards.
Meet monthly application and renewal targets and quality benchmarks monitored through program dashboards.
As assigned, provide one-on-one SHOP enrollment assistance to eligible small employers and educate them about the federal Small Business Health Care Tax Credit.