Enrollment Specialist I

Partnership HealthPlan of California•Fairfield, CA

3d•$30 - $35

About The Position

The Enrollment Specialist I assists in maintaining Medi-Cal membership and performs basic Enrollment Unit functions. The role reviews, researches, and resolves Medi-Cal eligibility issues, system-related errors, and primary care physician (PCP) assignment failures in accordance with established production and quality standards. The specialist completes reports and documents actions taken to correct or update member records and PCP assignments. The position also processes authorized representative forms, reports eligibility discrepancies and deceased members to appropriate counties, and adds newborn records after eligibility has been verified.

Requirements

High school diploma or equivalent.
One year of experience in health care, Medi-Cal, or Medicaid eligibility.
Thorough knowledge of managed care, Member Services policies, and Enrollment Unit procedures.
Excellent understanding of Partnership policies and procedures relating to all aspects of care.
Excellent understanding of external agencies that provide services to Partnership members.
Strong understanding of the Medi-Cal eligibility process.
Working knowledge of business software applications.
Proficient use of a computer keyboard to access data.
Effective written communication skills.
Strong organizational skills, including the ability to prioritize assignments and meet deadlines.
Ability to use good judgment within the scope of authority and handle confidential and sensitive issues with tact and diplomacy.
Ability to stay focused on repetitive work and meet production and quality standards.
Ability to understand and follow instructions.
Ability to be detail-oriented and maintain a high level of accuracy.

Nice To Haves

Customer service experience.
Bilingual skills in Spanish, Tagalog, or Russian.

Responsibilities

Process PCP assignments and reports.
Review and respond to eligibility questions and issues.
Process membership reports to ensure member records and PCP assignments are appropriate.
Monitor the E-Unit inbox and process Medi-Cal eligibility-related questions and requests.
Maintain and process out-of-area requests.
Process newborn-add requests and related tasks.
Participate in special projects, tasks, and assignments as needed.
Process duplicate records.
Communicate with county contacts to correct membership records, aid codes, and other county-level eligibility discrepancies.
Arrange face-to-face interpreting and reconcile invoices.
Process “no show” appointment requests.
Support and assist team members with their daily duties as needed.
Perform other duties as assigned.