Enrollment Specialist

2d4a5356-e068-4295-b443-4d720d34acb5•Los Angeles, CA

4h•$0 - $30

About The Position

The Enrollment Specialist assists patients with health insurance enrollment, Medi-Cal renewal and retention, CalFresh applications, and information about insurance plans accepted at the clinic. The role supports continuous health coverage through enrollment assistance, proactive outreach, renewal support, and follow-up. It works with patients at risk of losing Medi-Cal coverage, helps obtain missing application information and supporting documents, identifies barriers to continued coverage, and maintains accurate patient information in the Electronic Health Record (EHR) and designated tracking systems. The specialist must have the required qualification or be willing to complete the necessary training and certification to assist with health insurance enrollment and retention. The position provides enrollment and benefits guidance in the clinic and community; screens patients for eligibility; supports applications, renewals, plan selections, and PCP changes; and connects patients with transportation, interpretation, translation, and community resources. It also verifies eligibility, coordinates with DPSS and enrollment personnel when cases need additional help, documents outreach and case outcomes, and submits required productivity reports. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m.

Requirements

High School Diploma or equivalent.
CAA (Certified Application Assistor) certification; if not current at hire, it must be obtained within six months of hire.
Ability to communicate effectively verbally and in writing with patients, the public, medical staff, and physicians.
Hold or be willing to obtain the required certification to assist patients with health insurance enrollment within the designated timeframe.
Knowledge of EHR systems and accurate patient data entry.
Knowledge of health insurance programs, coverage options, and enrollment processes, including Covered California and Medi-Cal.
Excellent organizational skills and attention to detail.
Ability to work independently and demonstrate effective time management, prioritization, and follow-up skills.
Ability to maintain patient confidentiality and appropriately handle sensitive personal information.
Ability to provide clear information, assist patients with application documentation, and connect them with appropriate community resources.
Basic computer skills, including data entry, electronic recordkeeping, and use of tracking systems.
Ability to document patient interactions, maintain accurate records, and prepare routine productivity reports.
Ability to conduct proactive outreach, manage assigned termination and renewal lists, prioritize time-sensitive cases, and complete timely follow-up.
Strong organizational and case management skills, including the ability to manage multiple cases while meeting productivity expectations.
Ability to identify barriers to Medi-Cal retention and refer patients to the appropriate agency, department, or resource when additional assistance is needed.
Ability to work collaboratively with the Enrollment team, Enrollment Manager, and other relevant departments while independently managing assigned responsibilities.
Ability to comply with HIPAA requirements and applicable organizational privacy and security policies.
Punctual and regular attendance; report to work as scheduled and remain for the entire work schedule.

Nice To Haves

One year of experience in a medical office or related healthcare or patient enrollment setting.
CPR certification.
Experience in healthcare enrollment, Medi-Cal eligibility and renewals, patient outreach, customer service, or a related field.
Experience assisting patients with public health insurance programs or navigating government benefits systems.
Experience with telephone outreach, case follow-up, data entry, or maintaining tracking lists.
Bilingual Spanish-speaking skills.
Familiarity with CalFresh and General Relief (GR) programs and their application requirements.
Knowledge of Medi-Cal coverage, renewal processes, eligibility requirements, and common reasons for coverage termination.
Familiarity with the Los Angeles County Department of Public Social Services (DPSS), BenefitsCal, and Medi-Cal eligibility verification systems.
Strong telephone communication and patient service skills, including the ability to explain renewal requirements clearly and help patients navigate the renewal process.

Responsibilities

Educate patients about managed care and available health insurance coverage and plan options.
Screen patients for enrollment eligibility and schedule initial enrollment appointments.
Enroll patients in Covered California health insurance plans.
Review assigned Medi-Cal termination and renewal lists, identify patients at risk of losing coverage, and prioritize outreach based on deadlines and potential termination.
Conduct proactive telephone outreach to patients whose Medi-Cal coverage is approaching termination or has been discontinued; explain renewal requirements and deadlines.
Contact cash-paying patients and disenrolled members to assess eligibility, identify reasons for disenrollment, and assist with re-enrollment when appropriate.
Assist patients with CalFresh applications and renewals, including Semi-Annual Reports (SAR 7).
Help patients complete and submit Health Care Options and Medi-Cal health plan selection forms.
Contact health plans to request Primary Care Physician (PCP) changes on behalf of patients.
Help patients access transportation benefits through their health plans and obtain interpretation or translation services as needed.
Conduct outreach to increase patient enrollment and expand the clinic's patient roster.
Help patients identify and access community resources, including housing and employment assistance.
Provide eligible patients with information and application support for the Los Angeles County General Relief (GR) program, including help with required documentation as appropriate.
Explain Medi-Cal renewal notices, eligibility requirements, reporting obligations, deadlines, and supporting documentation to patients by telephone.
Guide patients through BenefitsCal to review renewal information and submit required documentation, as appropriate.
Assist patients in contacting the Los Angeles County Department of Public Social Services (DPSS) about pending renewals, missing documents, and eligibility questions.
Educate patients about keeping their contact information current with DPSS.
Identify patients who need help maintaining or restoring Medi-Cal coverage and explain reinstatement or reapplication options when coverage has ended.
Follow up on outstanding renewal requirements, missing documentation, and unresolved coverage issues until resolved or appropriately referred.
Coordinate with patients and enrollment personnel to support continued coverage and reduce preventable gaps in Medi-Cal enrollment.
Verify Medi-Cal eligibility and coverage status using authorized systems and established procedures.
Review eligibility information, renewal dates, and termination notices to identify potential coverage interruptions and determine follow-up actions.
Identify cases requiring additional documentation, eligibility clarification, or intervention from DPSS or another appropriate agency.
Refer patients to DPSS or appropriate enrollment personnel when additional assistance is needed beyond the position's scope.
Follow established procedures for communicating eligibility information and coordinating referrals.
Submit weekly reports documenting completed enrollments.
Accurately and promptly document outreach attempts, calls, enrollment and renewal assistance, referrals, and follow-up activities.
Maintain accurate, current records in the retention tracking system and applicable EHR systems.
Update retention tracking records with outcomes, including completed renewals, pending cases, unresolved issues, and discontinued coverage.
Submit daily productivity reports to the Certified Enrollment Manager according to departmental procedures.
Monitor assigned retention cases and identify patients who need additional outreach, documentation, or assistance.
Meet outreach, documentation, and productivity goals established by the Certified Enrollment Manager.
Communicate unresolved cases and barriers to enrollment or retention to the appropriate supervisor or department in a timely manner.
Contribute to reducing preventable Medi-Cal coverage losses and supporting continuity of patient access to healthcare services.
Perform other related duties as assigned.
Maintain patient, employee, and Foundation confidentiality; share protected health information only with appropriate parties who have a bona fide need to know and only to the minimum extent necessary.