Certified Application Counselor

Essen Medical Associates•New York, NY

19d•$22 - $23

About The Position

NYREACH is hiring a Certified Application Counselor – Medicaid Recertification Specialist to coordinate care and help Medicaid-eligible and enrolled patients maintain continuous health insurance coverage. The role supports patients through Medicaid applications, renewals, eligibility requirements, and coverage choices across NYREACH community-based programs and clinical partner sites in the Bronx. It focuses in particular on six-month renewal cycles and community engagement documentation requirements. The position also provides care coordination for patients with multiple chronic conditions through Health Home, Health Home Plus, HARP, and related programs. The Counselor works with patients and partner organizations to support continuity of care, document services and eligibility, and help people navigate insurance and social-service systems. Services are delivered within NYREACH’s community-rooted, health-equity-focused programs.

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.
If not already certified, demonstrate the ability and willingness to obtain certification within 30 days of hire.
Strong communication skills, including the 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.
One to two 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 doing Certified Application Counselor or Navigator work.
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-based outreach and follow-up.
Familiarity with EHR systems, 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

Coordinate care for patients with multiple chronic conditions through Health Home, Health Home Plus, HARP, and related programs across NYREACH’s clinical and community partner network.
Assist enrolled and transitioning patients with Medicaid recertifications and renewals, including six-month renewal requirements under H.R. 1, to help prevent coverage gaps.
Screen insurance status, identify eligibility gaps and approaching renewal deadlines, and conduct outreach to at-risk patients.
Complete and submit new applications and renewals through the NY State of Health enrollment portal, collecting and uploading required documentation.
Explain Medicaid, Essential Plan, and Qualified Health Plan options, out-of-pocket costs, metal tiers, advance premium tax credits, and appeals and complaints processes, while remaining neutral in plan selection.
Help patients meet and document H.R. 1 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, and follow-up to reduce no-shows and maintain appointment availability within established timeframes.
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, protect personally identifiable information under HIPAA and 45 CFR §155.260, and follow Navigator/Assistor conflict-of-interest standards.
Meet monthly application and renewal targets and quality benchmarks, including application completion, documentation upload at submission, and no-show rates.
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.