Healthcare Enrollment Specialist

St. Joseph's Health • Paterson, NJ

4d

About The Position

Responsible for assisting patients enroll in health insurance coverage and ensure they maintain accurate and timely eligibility. Support patients applying for health coverage through Healthcare.gov or state-based exchanges or through NJ Medicaid. Guide patients through choosing appropriate plans, completing required documentation, and navigating plan rules and deadlines. This role involves working closely with state health agencies, healthcare providers, and patients to ensure eligibility is accurately determined and documented.

Requirements

• 3 to 5 years of experience in healthcare enrollment
• High school diploma or equivalent required
• Working knowledge of health insurance terminology and plan structures (e.g., PPO, HMO, etc.)
• Proficiency in enrollment platforms and data entry systems
• Familiarity with HIPAA and ACA compliance requirements
• Ability to interpret and apply eligibility criteria and federal/state healthcare regulations
• Basic understanding of EDI (electronic data interchange) in healthcare
• Empathetic, patient-first communication style
• Strong attention to detail and accuracy in data handling
• Analytical thinking and problem-solving for eligibility questions
• Adaptability to regulatory and process changes
• Possesses and demonstrates excellent communication, organizational, technical, and interpersonal skills
• Ability to handle sensitive or confidential information with discretion
• Strong knowledge of Medicaid and Charity Care eligibility guidelines
• Previous work in a hospital, managed care organization, or insurance company
• Experience enrolling individuals in government or public health programs

Nice To Haves

• Associate’s degree in healthcare administration, public health, or related field preferred
• Bilingual fluency, particularly in Spanish, is highly preferred

Responsibilities

• Assisting patients enroll in health insurance coverage
• Ensure patients maintain accurate and timely eligibility
• Support patients applying for health coverage through Healthcare.gov or state-based exchanges or through NJ Medicaid
• Guide patients through choosing appropriate plans
• Completing required documentation
• Navigating plan rules and deadlines
• Working closely with state health agencies, healthcare providers, and patients to ensure eligibility is accurately determined and documented

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees