Enrollment Services Specialist

Lakeland Care•Fond du Lac, WI

About The Position

Join our award winning culture as we serve members in your area! Under the general supervision of the Enrollment Services Manager, the Enrollment Services Specialist is responsible for enrollment and eligibility coordination of Lakeland Care, Inc. (LCI) membership. The Enrollment Services Specialist ensures that member enrollment information is accurately maintained in the Wisconsin Forward Health system, CARES system, and Lakeland Care system. The Enrollment Services Specialist monitors the eligibility status of members in an assigned caseload and assists members as needed in fulfilling annual financial reporting requirements for Medicaid membership recertification. Essential Competencies: Oversee the data entry of member demographic and enrollment information into the TruCare System as well as any state systems; handle daily decisions and problem solving. Perform enrollment reconciliation tasks, to include reviewing Forward Health reports on pending and final enrollments and determine discrepancies with local systems; research and determine appropriate changes; and initiate and monitor corrections to safeguard member eligibility for Family Care programs. Evaluate member fulfillment of eligibility requirements and identify level of risk in continuing service to members with incomplete eligibility documentation. Refer members with high-risk eligibility for disenrollment. Monitor and evaluate Family Care enrollment trends in the assigned counties. Strive to maintain member eligibility by communication with members who are due for a Medicaid recertification review or become ineligible. Respond to member and staff questions regarding eligibility for Family Care and Medicaid. Meet with members, families, and IDT staff as needed to assist members with the Medicaid recertification process. Monitor and report costs associated with membership whose eligibility is at risk. Respect others’ opinions and concerns and value diversity in thought and action. Display a positive attitude and actively listen to others. Liaise between county Income Maintenance Specialists and IDTs regarding member eligibility issues. Work with the local Aging and Disability Resource Centers (ADRCs) to coordinate enrollment and disenrollment dates and member specific Family Care eligibility issues. Coordinate backup support coverage with Enrollment Manager Meet regularly with ADRCs and Income Maintenance agencies to maintain a collaborative approach to member service. --------------------------------------------------------------------- Lakeland Care is a Wisconsin-based non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), we provide long-term care services to eligible elders and individuals with physical and intellectual or developmental disabilities. Currently we serve members in 22 counties and have 11 offices throughout the Central to North East region of Wisconsin. Our Mission Empowering individuals. Strengthening communities. Inspiring futures. Our Vision To create a world we all want to live in. Our Core Values Kindness – We believe kindness is always possible and that no compassionate act is ever wasted. Inclusion – We believe that open hearts and open minds are the only path to a brighter future. Trust – We believe that honesty is still in style and that promises still have power. We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. We are an organization that participates in E-Verify.

Requirements

Bachelor’s degree in Business Management, other related field, or equivalent combination of education and experience (includes knowledge, skills, and abilities).
Minimum of two (2) years’ experience in Medicaid eligibility.
Considerable knowledge in automated systems and software including MS Office Suite products and Spreadsheet applications.
Knowledge of state Medicaid information systems (Forward Health and CARES) beneficial.
Experience in a health care, human services, and/or non-profit agency setting.
Exemplary customer service skills.
Strong written and verbal communication skills.
Strong time management and organization skills.
Ability to function effectively in a fast-paced and changing environment with multiple priorities and objectives required.
Ability to comprehend complex material and concepts and apply them to varying situations.
Ability to communicate complex concepts to members and families in empathetic yet businesslike manner.
Current driver’s license, acceptable driving record and proof of adequate insurance required.

Nice To Haves

Experience with the TruCare System or similar product a plus.

Responsibilities

Oversee the data entry of member demographic and enrollment information into the TruCare System as well as any state systems; handle daily decisions and problem solving.
Perform enrollment reconciliation tasks, to include reviewing Forward Health reports on pending and final enrollments and determine discrepancies with local systems; research and determine appropriate changes; and initiate and monitor corrections to safeguard member eligibility for Family Care programs.
Evaluate member fulfillment of eligibility requirements and identify level of risk in continuing service to members with incomplete eligibility documentation.
Refer members with high-risk eligibility for disenrollment.
Monitor and evaluate Family Care enrollment trends in the assigned counties.
Strive to maintain member eligibility by communication with members who are due for a Medicaid recertification review or become ineligible.
Respond to member and staff questions regarding eligibility for Family Care and Medicaid.
Meet with members, families, and IDT staff as needed to assist members with the Medicaid recertification process.
Monitor and report costs associated with membership whose eligibility is at risk.
Respect others’ opinions and concerns and value diversity in thought and action.
Display a positive attitude and actively listen to others.
Liaise between county Income Maintenance Specialists and IDTs regarding member eligibility issues.
Work with the local Aging and Disability Resource Centers (ADRCs) to coordinate enrollment and disenrollment dates and member specific Family Care eligibility issues.
Coordinate backup support coverage with Enrollment Manager
Meet regularly with ADRCs and Income Maintenance agencies to maintain a collaborative approach to member service.