Enrollment Specialist

The purpose of the Health Advocate is to work within the communities we serve, to identify community leadership and community members who are eligible for County Health programs, State programs such as Medi-Cal and Covered CA (Affordable Care Act), provide all program insurance information, assist in filling out applications for the members of the community and assist prospects in enrolling for these health insurance programs.

The Health Advocate will also help empower individuals to overcome enrollment problems for all county and state programs such as Medi-Cal and Covered CA, and health access barriers. The Health Advocate will conduct outreach and in-reach efforts to current and potential members of Queens Care Health Centers. The Health Advocate functions as a community organizer, health insurance  broker , by identifying appropriate health coverage that the prospect qualifies for, promotes health insurance utilization and retention and helps recruit new members to the Queens Care Health Centers.

ESSENTIAL

JOB DUTIES AND RESPONSIBILITIES:

1. Support and implement the organizations vision, mission and values
2. Determines priorities and method of completing daily workload to complete responsibilities in a timely manner.
3. Performs all job functions in a professional and courteous manner. This includes answering all phone calls and emails timely and providing excellent customer service to internal and external customers.
4. Maintain expertise in eligibility, enrollment and program specifics for all county and state programs such as, Covered CA and Medi-Cal and all programs accessible to our community.
5. Provide information in a fair, accurate and impartial manner.
6. Develop and maintain updated information to help understand the composition of the communities in the service area, including the primary languages spoken. 7. For Covered CA, the Certified Enrollment Counselor (CEC) must wear the Covered CA assigned badge when enrolling or disseminating information regarding Covered CA. 8. Fosters and promotes a culture of service excellence and accountability.
9. Assist eligible families with completing and submitting the appropriate health insurance application/s, including assistance with gathering necessary documents and resolving problems. 10. Process applications using Health-E-APP, One-E-APP, CALHEERS or other web-based programs. 11. Conduct client to perform intakes by phone and in person to determine their immediate healthcare needs and connected them to the proper resources. 12. Provide support and education to assist families when a problem with health coverage arises.

May act as family liaison with various health coverage programs. 13. Provide education and information to families about utilization of health coverage, plan benefits, and maintaining coverage.
14. Promote awareness and access to healthcare through no-cost/low-cost health coverage programs 15. Review applications for completeness and accuracy to include paper and/or electronic applications for county and state programs such as Medi-Cal or Covered CA. 16. Maintain CEC certification to access the CALHEERS and Covered CA web sites for enrollment purposes 17. Assist with health education and outreach opportunities in the community such as health fairs, presentations, and special events as needed.

18. Demonstrate ability and flexibility to work in other areas and/or locations of the organization as needed. 19. Track all applications and help families with appeals when appropriate 20. Contact families at the time their annual renewal is due to offer re-enrollment assistance. 21. Contact potential leads identified at Outreach Events (Health Fairs, Resource Fairs, etc.) to schedule enrollment appointments 22.

Conduct in-reach by contacting families associated with Queens Care Health Centers as needed. 23. Refer families to appropriate community programs according to each family's needs. 24. Attend monthly training meetings, and other periodic trainings to retain the most current understanding of enrollment programs. 25. Maintain the most current and up-to-date knowledge of Health Plans, Health Insurance(s), Program Eligibility, Medi-Cal updates, Medi-Care updates, Federal/State/County programs updates and all other health programs available to current and prospective patients of QHC.

26. Complete data tracking, monthly reports and client file-related paperwork on a routine basis. 27. Perform outbound calls to members aging into Medi-Care 28. Perform…