Medicaid and Community Resource Enrollment Coordinator

Primary Health Solutions•Middletown, OH

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About The Position

Our Mission We meet people where they are and partner with them on their journey towards wellness. Our Vision The destination for servant leaders to provide comprehensive and exceptional care. Our Values R – Respect I – Innovation S – Stewardship E – Excellence Outreach and Enrollment Specialist Summary Collaborate with the clinical team and families of patients to enroll eligible patients in insurance programs. Duties and responsibilities include increasing access to care through application and enrollment assistance for people who may be eligible for the new affordable insurance options available beginning in 2014. A Day in the Life This job description reflects management's assignment of essential functions. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. · Respond to incoming requests for assistance regarding the application and enrollment process. · Provide information in a fair, accurate, and impartial manner. · Remain current with eligibility requirements. · Work cooperatively with PHS providers and personnel to carry out goals and objectives of Outreach and Enrollment. · Provides leadership for the implementation and coordination of O&E activities such as hosting enrollment events, some after or before normal business hours, evenings and weekends. · Develop presentations for community groups and referral sources. · Attend all required training sessions at the federal, state and local level and meetings concerning O&E. · Safeguard data, maintain strict confidentiality of information, and perform required reporting. · Accurately complete data collection and enrollment process. · Conduct “in reach” with currently uninsured PHS patients and “outreach” with non-PHS patients in all service areas. · Monitor and report all patient correspondence including patient/non-patient completed enrollments. · Develop relationships with appropriate community partners. · Provide educational materials regarding insurance options to community partners including health departments, hospitals, urgent cares, physician’s offices, and human services agencies and collaborate and coordinate outreach efforts with them. · Develop a referral tracking system. · Organize work to meet goals, objectives, and deadlines. · Multi-task and prioritize duties. · Develop promotional materials at the appropriate literacy level. · Other duties assigned by the Director of Quality Operations. · Ensure all PHSs have timely and necessary information about Ohio’s consumer assistance training requirements and the roll-out of new affordable health insurance options. · Coordinate PHS O/E activities with other consumer assistance efforts in the state. · Provide technical assistance and training on effective O/E strategies and targeted technical assistance to PHSs experiencing challenges. · Monitor successes and barriers to PHS O/E activities. · CACs are expected to provide the following services to consumers, applicants, qualified individuals, enrollees, qualified employees, and qualified employers, and/or these individuals’ legal representative(s) or Authorized representatives: o Provide information about the full range of Qualified Health Plans (QHPs) options and Insurance Affordability Programs for which these persons are eligible o Assist with applications for coverage in a QHP through the FFE and for Insurance Affordability Programs o Help to facilitate enrollment in QHPs and Insurance Affordability Programs (p. 1, Agreement between the CMS and CACDO). · CACs are permitted to create, collect, disclose, access, maintain, store, or use Personally Identifiable Information (PII) from consumers. · CACs are to access the CAC training hosted by the Medicare Learning Network (MLN), to complete required training and complete all exams to obtain certification. · CACs must print the certificate of completion and provide it to PHS. · CACs must submit conflict of interest disclosure forms to PHS’s CAC project lead. · CACs should ensure they have read carefully and signed the CAC agreement with PHS. · CACs must prominently display their CAC certificate whenever assisting a consumer. · CACs must maintain a registration process and method to track the performance of CACs. · CACs are encouraged to provide information and assistance with exemptions and with other health coverage programs, such as drug assistance programs and programs funded under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, but these are not required duties. · Performs all other duties and tasks as assigned.

Requirements

Bachelor’s degree in human services field, or equivalent experience.
Experience in planning and implementing projects and coordination of functions, and setting goals and meeting timelines.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of organization.
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
To perform this job successfully, an individual should have the ability to gain knowledge of current practice management system, electronic medical record, Microsoft Word, text paging, Internet, and Intranet.
Comply with all applicable federal and state training certificates, licenses, and registrations related to the development of expertise in eligibility, enrollment, and program specifications.
Obtain insurance licensure, as required.
Valid driver’s license, and proof of automobile insurance.

Nice To Haves

Skill with geriatric patients and patients in lower socio-economic sectors of the community.
Ability to speak Spanish desirable.

Responsibilities

Respond to incoming requests for assistance regarding the application and enrollment process.
Provide information in a fair, accurate, and impartial manner.
Remain current with eligibility requirements.
Work cooperatively with PHS providers and personnel to carry out goals and objectives of Outreach and Enrollment.
Provides leadership for the implementation and coordination of O&E activities such as hosting enrollment events, some after or before normal business hours, evenings and weekends.
Develop presentations for community groups and referral sources.
Attend all required training sessions at the federal, state and local level and meetings concerning O&E.
Safeguard data, maintain strict confidentiality of information, and perform required reporting.
Accurately complete data collection and enrollment process.
Conduct “in reach” with currently uninsured PHS patients and “outreach” with non-PHS patients in all service areas.
Monitor and report all patient correspondence including patient/non-patient completed enrollments.
Develop relationships with appropriate community partners.
Provide educational materials regarding insurance options to community partners including health departments, hospitals, urgent cares, physician’s offices, and human services agencies and collaborate and coordinate outreach efforts with them.
Develop a referral tracking system.
Organize work to meet goals, objectives, and deadlines.
Multi-task and prioritize duties.
Develop promotional materials at the appropriate literacy level.
Other duties assigned by the Director of Quality Operations.
Ensure all PHSs have timely and necessary information about Ohio’s consumer assistance training requirements and the roll-out of new affordable health insurance options.
Coordinate PHS O/E activities with other consumer assistance efforts in the state.
Provide technical assistance and training on effective O&E strategies and targeted technical assistance to PHSs experiencing challenges.
Monitor successes and barriers to PHS O/E activities.
CACs are expected to provide the following services to consumers, applicants, qualified individuals, enrollees, qualified employees, and qualified employers, and/or these individuals’ legal representative(s) or Authorized representatives:
Provide information about the full range of Qualified Health Plans (QHPs) options and Insurance Affordability Programs for which these persons are eligible
Assist with applications for coverage in a QHP through the FFE and for Insurance Affordability Programs
Help to facilitate enrollment in QHPs and Insurance Affordability Programs (p. 1, Agreement between the CMS and CACDO).
CACs are permitted to create, collect, disclose, access, maintain, store, or use Personally Identifiable Information (PII) from consumers.
CACs are to access the CAC training hosted by the Medicare Learning Network (MLN), to complete required training and complete all exams to obtain certification.
CACs must print the certificate of completion and provide it to PHS.
CACs must submit conflict of interest disclosure forms to PHS’s CAC project lead.
CACs should ensure they have read carefully and signed the CAC agreement with PHS.
CACs must prominently display their CAC certificate whenever assisting a consumer.
CACs must maintain a registration process and method to track the performance of CACs.
CACs are encouraged to provide information and assistance with exemptions and with other health coverage programs, such as drug assistance programs and programs funded under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, but these are not required duties.
Performs all other duties and tasks as assigned.