Job Description

Join Elica’s mission and become a part of a team where every day is an opportunity to make a positive impact in your community!

At Elica Health Centers, we share a common goal: provide the best possible patient care to our growing community! Our passion extends throughout Elica, from the exceptional healthcare services we provide to our underserved patients at our Community Health Clinics and state-of-the-art mobile medicine program, Health on Wheels, to our Resource Center where we empower patients and members of the community to connect with resources to help them build healthy and full lives.

We are growing our CalAIM program at Elica! CalAIM (California Advancing and Innovating Medi-Cal) is the statewide Medi-Cal benefit available to select “Populations of Focus" with complex needs and who are facing difficult life and health circumstances, including lack or unstable housing. This program is focused on breaking down the

traditional walls of health care – extending beyond hospitals and health care settings into communities.

WHAT YOU'LL DO:

CalAim Financial Counselor (ECM) is responsible for verifying client eligibility for the Enhanced Care Management (ECM) . and Community Supports (CS) program participation, coordinating and maintaining service referral records, obtaining, tracking and maintaining appropriate documentation on authorizations to support both Care Managers, Community Health Workers and Clients.

CalAim Financial Counselor coordinates and ensures the smooth flow of the referral to meet the needs of the CalAim billing and reimbursement team. The CalAim Financial Counselor is part of the ECM program but works in close contact with the CalAIM Billing Specialist and CalAIM Reimbursement Specialist, attends all meetings that apply to the eligibility process to know all news and updates in their field to give feedback when working with ECM clients, and helps with projects when changes occur with ECM services.

The CalAim Financial Counselor works with Elica patients and future patients referred by MHPs who may qualify for ECM services, understands precisely how to verify patient coverage so that Elica can bill properly for ECM services, and understands precisely how to verify patient authorization as well as to submit authorizations for the ECM services so that Elica can bill properly for ECM services.

The ECM team is a part of the Social Care Department and works in close collaboration with CS and other support programs.

BENEFITS:

Elica is proud to offer an exciting benefits package to qualifying full-time employees which can support your health, your family, and help you plan for the future.

• Retirement Savings Made Easy: Enjoy a 403(b) retirement plan with up to 4% employer matching and 100% immediate vesting—start building your future from day one!
• Comprehensive Healthcare Options: Choose from two Anthem Blue Cross PPO plans for medical, plus dental and vision coverage for you and your family.
• Employer-Funded HRA: Our Health Reimbursement Arrangement helps cover out-of-pocket medical costs, giving you peace of mind.
• Flexible Spending Accounts: Take advantage of two FSA options: Health Care FSA and Dependent Care FSA, tailored to suit your needs.
• Security for the Unexpected: We provide company-paid basic Life and AD&D Insurance, with options to enhance coverage.
• Enhanced Protection: Explore additional benefits like Hospital Indemnity, Critical Illness, and Accident Insurance, plus ID Theft Protection and Pet Insurance
• Time to Recharge: Enjoy accrued paid time off, paid holidays, and Employee Assistance Plan (EAP) access, which includes counseling, financial, and legal services, along with a vast library of online resources.
• Invest in Yourself: Benefit from our Tuition Reimbursement Program for ongoing education and growth, plus CME/CEU and license reimbursements for eligible roles.

This is more than just a benefits package—it’s a commitment to your health, well-being, and professional success!

Learn more about Elica’s services and mission at our website or check us out on Facebook

Compensation - Dependent Upon Experience

$25.00 - $28.00/hr

Requirements

WHAT ARE WE LOOKING FOR?

The successful candidate will be willing and able to:

• Perform pre-outreach activities for new clients referred by Managed Care Plans (MCPs), such as verifying eligibility, adding an appropriate Guarantor Account and Episode to EHR.
• Independently Manages at least one ECM Referrals EPIC WorkQueues by actively monitoring referral statuses and processing new referrals;
• Tracks the status of authorization requests;
• Tracks and resubmits re-authorization requests as required by MCPs by coordinating with ECM Care Managers;
• Coordinates with the CalAIM Quality Assurance Specialist and CalAIM Reimbursement Specialist to track and update authorizations issued by MCPs;
• Checks eligibility of members in outreach and enrolled programs stage at the minimum of twice a month;
• If a patient switches MCPs and Elica is in contract with MCP for ECM, submits and tracks prior-authorization;
• If the patient loses coverage, is no longer enrolled into any MCPs or switches MCP to one not contracted for ECM services, notifies an appropriate ECM Care Manager or Community Health Worker to work with the patient on either regaining coverage or transferring to Health Plan for reassignment to a contracted provider;
• For patients internally referred to ECM, checks patients’ eligibility for contracted ECM and CS services;
• Coordinates with the CalAIM Reimbursement Specialist and CalAIM Billing Specialist in regards to billing issues;
• Assists the CalAIM Manager in maintaining accurate program enrollment data and flagging program enrollment discrepancies;
• Provides accurate data entry of referral or authorization information into the electronic medical record.
• Consistently utilizes the department's documentation protocols.
• Assists with the Resource Center visitors who are interested in being in the ECM and/or CS program by educating them on the program and program eligibility.
• Attends Team and Managed Care Plan meetings;
• Maintains consistent attendance and punctuality;
• Other duties as assigned.

The successful candidate has:

Education and Experience

• Minimum of an Associate degree in any field and minimum of two years of experience with eligibility and/or referrals OR a minimal experience of 3 years in eligibility and/or referrals related field;
• Prior experience with CalAIM programs - Preferred but not required;
• Prior experience using Electronic Health Records systems- Epic Preferred.

Essential Skills/Abilities:

• Computer and technology skills;
• Excellent computer skills in a Microsoft Windows environment. Must include knowledge of Excel and skills in Google Workspace;
• Better than average written and spoken communication skills;
• General knowledge of various MHPs and state programs;
• Excellent organizational and time management skills;
• Ability to work with minimal supervision and use good judgment, at times under the pressure of deadlines;
• Adherence to all Elica policies including but not limited to: standards of conduct, time and attendance.

Additional Requirements:

• If selected for an employment opportunity with Elica Health Centers, external hires must provide proof of immunizations (Hepatitis B, MMR, Varicella & Tetanus), tuberculosis clearance, and proof of COVID-19 vaccination status* prior to their scheduled start date. Please be advised that this position is subject
• to criminal background investigation and drug screen.
• This position is non-exempt and subject to timekeeping requirements.
• Employees are required to clock in and clock out accurately at the beginning and end of each shift, as well as during meal and rest breaks.
• This is a fully on-site, office-based position (5735 Watt Avenue, North Highlands, CA 95660).

Physical Requirements

Physical Requirements and Work Environment

The work environment is characteristic of normal office conditions. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit; use hands to handle or lift. The employee is occasionally required to stand; walk; and reach with hands and arms. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. The employee must also possess hearing and speech to communicate in person and over the phone. The noise level in the work environment can range from quiet to moderately loud; the incumbent must be able to focus in an environment with many distractions. The employee may be required to run agency related errands and attend off-site meetings; the employee must be able to operate, maneuver and/or control a motor vehicle. In performing the driving responsibilities, the driver may sit for long periods. This requires intense concentration, particularly in poor driving conditions.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

*Elica Health Centers is a healthcare facility that adheres to the mandates issued by the California Department of Public Health including the recent orders regarding the COVID-19 vaccine. Medical and religious exemptions will be considered.