Enrollment Specialist I

Partnership HealthPlan of California•Fairfield, CA

13d•$29 - $34

About The Position

The Enrollment Specialist I will assist in maintaining Medi-Cal membership and process basic functions of the Enrollment Unit. This position will review, research, and resolve Medi-Cal eligibility issues and systems related errors as well as primary care physician (PCP) assignment failures within established production and quality standards. Completes and processes reports and appropriately documents member records of actions taken to correct or update member records, PCP assignments etc. Processes reports to ensure primary care assignment is appropriate, processes certain authorized representative forms and document members records appropriately. Reports eligibility discrepancies and deceased members to appropriate counties and adds newborn records upon request and after verification of eligibility.

Requirements

High School Diploma or equivalent; one (1) year experience in health care or Medi-Cal or Medicaid eligibility.
Thorough knowledge of managed care and Member Services Policies and Enrollment Unit procedures.
Excellent understanding of all PHC policies and procedures relating to all aspects of care.
Excellent understanding of external agencies that provide services to PHC members.
Strong understanding about the Medi-Cal eligibility process.
Working knowledge of business software applications.
Proficient use of computer keyboard to access data.
Effective written communication skills.
Excellent organization skills with ability to prioritize assignments and meet deadlines.
Ability to use good judgment within the scope of authority and to 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.
Must have excellent organization skills and be detail oriented with a high level of accuracy.

Nice To Haves

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

Responsibilities

Processes PCP assignments and reports.
Reviews and responds to eligibility questions and issues.
Processes a variety of membership reports to ensure members records as well as PCP assignments are appropriate.
Monitors the E-Unit inbox and processes all Medi-Cal eligibility related questions and requests.
Maintains and processes out of area requests.
Processes all related newborn add requests etc.
Participates in special projects, tasks, and assignments, as needed.
Processes duplicates records.
Communicates with county contacts to correct membership records, aid codes or other eligibility discrepancies at the county level.
Arranges face to face interpreting and reconciles invoices.
Processes “no show” appointment requests.
Supports and assists team members in their daily duties as needed
Other duties as assigned