Enrollment Specialist I

APLA Health•West Hollywood, CA

35d

About The Position

POSITION SUMMARY: Under the direction of the Enrollment & Eligibility Manager, and in accordance with HRSA contract requirements, the Enrollment Specialist I assists clients, either directly or through referral, with enrollment/re-enrollment in Covered CA, Medi-Cal, Medicare, and MHLA, as well as with the process of accessing Public Benefits. ESSENTIAL DUTIES AND RESPONSIBILITIES: Screen clients using PointCare for eligibility in and assist with enrollment/re-enrollment in Covered CA, Medi-Cal, Medicare, MHLA, commercial products, Ryan White, ADAP, and PrEP-AP as well as with the process of accessing Public Benefits. Serve as the APLA Health & Wellness point of contact for addressing issues related to health plans that are part of independent physicians associations (IPAs) that APLAHW contracts with, including, but not limited to Health Care LA IPA and Regal Medical Group. Documents contacts and maintains files, utilizing Point Care for enrollment allowing them to accurately qualify and enroll patients into coverage, faster. Stays current with APLA Health programs. Follow up to verify the status of enrollment applications and assist clients who are experiencing problems. Complete a comprehensive benefits and qualified health insurance assessment for each client. Maintain and update all client records via eClinicalWorks electronic health record system and reviews to verify and ensure data entered are accurate. Answer and respond to incoming telephone calls and emails regarding eligibility in qualified health plans and Public Benefits according to agency policy. Describe what a summary of benefits document is and where to locate a summary of benefits. Explain where to find information about provider networks. Collaborate with other programs at APLA Health & Wellness and other service organizations to facilitate the provision of services. Maintain an extensive awareness of client resources, both agency-wide and Federally Qualified community based healthcare organization (FQHC). Prepare reports and client records as required to meet APLA Health & Wellness, city, state, and federal program requirements. Follow agency policies and maintain agency standards with regards to client confidentiality and HIPAA compliance. OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

Requirements

A high school diploma and 1 year experience in beneftis enrollment.
Must be trained as a Medi-Cal Enroller, Covered CA Certified Enrollment Counselor (CEC) and ADAP/OA HIPP/PrEP-AP Enroller or acquire these certifications within six (6) months of hire.
A proficiency in writing, proofreading and grammar skills is important, as well as interpersonal customer service skills.
Bilingual Spanish/English required.
Interviewing and assessment techniques
Vocational rehabilitation and/or related occupational fields, knowledge of word processing and eClinicalWorks electronic health records data entry
HIV disease and related chronic illness and disability issues
Comprehensive understanding of public benefits programs and policies
Qualified health plans, including, but not limited to Covered CA, Medi-Cal, Medicare, My Health LA, and Ryan White.
Must have knowledge of the healthcare field.
Work under minimal supervision
Assess psychosocial and occupational/vocational needs
Utilize agency and community resources
Communicate effectively (orally and in writing) in both one-on-one and public settings
Respond with empathy to the needs of clients, staff and volunteers
Participate as a member of a team operating in a diverse, multi-cultural environment.
Must possess a valid California drivers license
Proof of auto liability insurance
Have the use of a personal vehicle for work related purposes.

Responsibilities

Screen clients using PointCare for eligibility in and assist with enrollment/re-enrollment in Covered CA, Medi-Cal, Medicare, MHLA, commercial products, Ryan White, ADAP, and PrEP-AP as well as with the process of accessing Public Benefits.
Serve as the APLA Health & Wellness point of contact for addressing issues related to health plans that are part of independent physicians associations (IPAs) that APLAHW contracts with, including, but not limited to Health Care LA IPA and Regal Medical Group.
Documents contacts and maintains files, utilizing Point Care for enrollment allowing them to accurately qualify and enroll patients into coverage, faster.
Stays current with APLA Health programs.
Follow up to verify the status of enrollment applications and assist clients who are experiencing problems.
Complete a comprehensive benefits and qualified health insurance assessment for each client.
Maintain and update all client records via eClinicalWorks electronic health record system and reviews to verify and ensure data entered are accurate.
Answer and respond to incoming telephone calls and emails regarding eligibility in qualified health plans and Public Benefits according to agency policy.
Describe what a summary of benefits document is and where to locate a summary of benefits.
Explain where to find information about provider networks.
Collaborate with other programs at APLA Health & Wellness and other service organizations to facilitate the provision of services.
Maintain an extensive awareness of client resources, both agency-wide and Federally Qualified community based healthcare organization (FQHC).
Prepare reports and client records as required to meet APLA Health & Wellness, city, state, and federal program requirements.
Follow agency policies and maintain agency standards with regards to client confidentiality and HIPAA compliance.