Eligibility and Enrollment Specialist

Eligibility and Enrollment Specialist

SUMMARY:

The Eligibility and Enrollment Specialist (EES) will be responsible for increasing access to medical care through health insurance applications and enrollment assistance for homeless children and adults. The EES will provide outreach and education to patients regarding health services available at CFH and in the community, and they will strengthen enrollment collaborations with partner organizations.

This employee will work as part of the PCMH team. Enrollment is based on patient care needs and scope of the practice and follows the principles of Trauma Informed Care.

ESSENTIAL DUTIES AND RESPONSIBILITIES  

Outreach

• • Outreach to uninsured clients by phone, mail, or in-person to promote health insurance enrollment.
  • Document outreach encounters in eClinical Works using telephone encounters.
  • Escort clients as necessary to obtain documents to enroll in health insurance, as needed.
  • Develop and distribute appropriate outreach materials to patients and partner organizations to increase insurance coverage option awareness and applicable Affordable Care Act (ACA) provisions.
  • Travel within CFH health centers and the community to provide insurance enrollment, as required.

Insurance Education

• • Educate clients on medical, behavioral, and dental health services available within CFH, and beyond.
  • Provide structured client education on Medicaid and other insurance programs.
  • Refer clients in need of medical services to a CFH health center and in the community.
  • Use Unite Us to search for community organizations and programs based on client’s need.

Health Insurance Enrollment

• • Provide insurance enrollment assistance for uninsured patients, including but not limited to completing applications, gathering required documentation, and troubleshooting the enrollment process.
  • Utilize health insurance verification systems such as ePaces, Availity and MCOs Portals to verify health insurance information.
  • Work with NY State of health Marketplace to submit applications, client’s documents, and file complaints, as necessary.
  • Document insurance application encounters in eClinical Works, excel spreadsheets and Daily activity logs.
  • Collaborate with partner organizations to increase enrollment in Medicaid, Essential plans, and other health insurances.
  • Assist clients with PCP selection by phone, or in person.
  • Attend and successfully complete all required training programs and participate in on-going trainings and webinars, as necessary.
  • Assist in the development and implementation of organizational eligibility and enrollment initiatives.
  • Perform additional duties, as required.

Qualifications

JOB QUALIFICATIONS:

• Education: Bachelor’s Degree Preferred
• Experience:
  • 1-2 years of experience in program development within a health services agency preferred.
  • Certified Application Counselor with NY State of Health Marketplace, preferred.
  • Previous experience with ePaces, Availity, and eClinical works, preferred.
• Skill Sets:
  • Excellent organizational and communication skills required.
  • Ability to multi-task and meet assigned deadlines from a variety of management staff.
  • Ability to work in a fast-paced and ever-changing environment.
  • Leadership and/or facilitation experience with a group or team
  • Public presentation and speaking skills
  • Bilingual Spanish strongly preferred. 
  • Extremely proficient in Microsoft Office Suite; the employee is willing and able to:
    • Create, edit and interpret charts, tables and spreadsheets (via Microsoft Excel).
    • Effectively manage, filter and sort data (via Microsoft Excel).
    • Create well-organized documents and outlines (via Microsoft Word).
    • Manage mailbox and calendar (via Microsoft Outlook).