Enrollment Specialist

Overview

The Enrollment Specialist is the primary point of contact for Mosaic patients with insurance applications and eligibility requirements with state and/or federal insurance programs, including Oregon Health Plan. This role involves contacting patients for re-enrollment, assisting the Billing Department with insurance verifications, conducting outreach with community partners and other organizations to provide information and enrollment assistance. The position develops and maintains enrollment reports and manages reports provided by the organization for enrollment and re-enrollment.

The role travels regionally to support enrollment assistance and handles pre-registration and pre-verification for all patients at Mosaic, new or established. It includes entering, auditing, educating, and advocating for accurate registration in the patient’s electronic medical record (EHR). The role identifies patients who have termed from Medicaid/Medicare and, when termed, follows up to understand why and assists patients in navigating the enrollment process.

Provides education on Medicaid eligibility and sliding-scale eligibility. Bi-lingual in Spanish/English strongly preferred.

• Aid and process state and/or federal applications for insurance coverage for patients and community members.
• Troubleshoot application questions or concerns from patients and community members.
• Serve as a liaison between state/federal systems and patient, providing timely follow-up and processing of applications and insurance eligibility status.
• Timely documentation of all assistance including insurance eligibility status in the electronic medical record (EMR) per procedure.
• Monitor enrollment reports to identify enrollment assistance needs.
• Active patient outreach to capture patient eligibility status at patient visit.
• Community outreach to educate and assist community members with enrollment needs.

• Monitor enrollment reports to identify enrollment assistance needs.
• Active patient outreach to capture patient eligibility status at patient visit.
• Community outreach to educate and assist community members with enrollment needs.

• Advise patients of their Enrollment status with Medicaid/Medicare and aid as needed.
• Advise patients of financial and/or insurance documentation required for appointments and educate patients on different payment options offered.

• Schedule patients in Enrollment appointments as needed.
• Provide system or clinic support for New Patient and Enrollment scheduling, rescheduling, and cancellations.
• Confirm patient demographics, registration, and insurance information and update EHR as needed.
• Promote and educate, MyChart use.

• Create new patient records in EHR.
• Patient activation and education on use and benefits of MyChart.
• Complete the patient registration process and document in the EHR.
• Educate patients on FPL, Medicaid, and Marketplace requirements and assist with over the phone support when possible.

• Auditor of patient charts to ensure accurate financial registration.
• Update patient charts to ensure accurate financial registration including coverage, guarantors, demographics, annual incomes, and any other registration field that needs correcting.
• Reach out to patients to obtain updated corrected information for accurate financial registration.
• Coordinate needed paperwork and forms for patients with billing and site supervisors.
• Manage messages related to registration updates, Medicaid eligibility, and sliding-scale eligibility.

Working knowledge of health insurance plans including Medicaid and Medicare. Excellent oral and written communication skills, including effective communication with patients on complex or technical information regarding insurance coverage. Ability to develop and present effective presentations in different location settings and group sizes. Ability to prepare basic correspondence and simple reports in Microsoft Word and Excel. Ability to create, send and manage email in Outlook.

Ability to access and use web-based applications and EMR programs. Understanding of healthcare navigation including insurance types, concepts, terminology, billing, and regulations. Knowledge of standard office policies and procedures. Knowledge of Microsoft Office software products preferred. Computer literacy and typing skills. Training in Marketplace enrollment preferred. Knowledge of standard office machines including copier, fax, shredder, multi-line telephone, printers, etc. Bi-lingual in Spanish/English strongly preferred.