Job Description

TEMPORARY POSITION

FLSA Status: Non-Exempt
Department: Operations
Reports To: Manager, Enrollment & Eligibility

GENERAL DESCRIPTION OF POSITION

The Enrollment Coordinator I provides timely data analysis, data entry, tracking, validation, monitoring, reporting and supporting communications to maintain accurate enrollment and eligibility data for one or more lines of business in compliance with all applicable Medicare and Medi-Cal regulatory requirements, SCFHP policies and procedures, and SCFHP business requirements, to achieve Department performance objectives.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

1. Complete data entry for Medicare paper applications; complete workflow tasks for all Medicare enrollment and disenrollment requests (including for applications received via mail, the Medicare Online Enrollment Center, auto and facilitated web-based submission); complete any associated member reconciliation tasks, including outreach to members if information on application is incomplete; initiate all associated correspondence; complete all of the above accurately, in accordance with the Centers for Medicare and Medicaid Services (CMS) guidelines, and in compliance with any DHCS requirements.
2. In response to internal and external inquiries and information, and in support of initiatives, work collaboratively with others to analyze, verify and resolve beneficiary enrollment, disenrollment, eligibility, demographics, and primary care provider assignment changes and issues in an accurate, timely, respectful, professional and culturally competent manner; communication may be via inbound call, outbound call, in-person, fax, email, mail, or other appropriate communication channel.
3. Accurately document and code all contacts and follow-up actions for member, provider and other communications and activities in accordance with established guidelines.
4. Track, analyze, validate and process assigned daily, weekly, and monthly enrollment and membership eligibility, integrity, audit, reconciliation/validation, and error reports accurately and in a timely manner.
5. Identify, investigate, troubleshoot, and report eligibility and enrollment issues, errors and/or discrepancies.
6. Provide input to required internal and external reporting, including dashboards.
7. Ensure process for delivering member materials to new and existing members is completed accurately and within the required timeframe.
8. Use operating instructions and tools needed to support department activities and to ensure compliance with all regulations.
9. Provide direct support for new member enrollment and for member retention via inbound and/or outbound calling, including outbound calls to verify Medicare enrollment and disenrollment.
10. Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.
11. Identify issues and report relevant information to management.
12. Provide support for implementation/upgrade/improvements of internal systems that support department processes; includes but is not limited to providing input to requirements and reporting results and potential defects.
13. Perform other related duties as required or assigned.

REQUIREMENTS – Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

1. High School Diploma or GED. (R)
2. Minimum one year of experience in jobs requiring interaction with members/patients/clients/customers, with preference for experience working in a health care setting. (R)
3. Able to efficiently alternate focus between telephone and non-telephone tasks to support Department operations as dictated by business needs. (R)
4. Prior experience with managed care plans, Medi-Cal and Medicare programs, and working with underserved populations. (D)
5. Work weekends and company holidays as needed based on business and regulatory requirements. (R)
6. Spanish, Vietnamese, Chinese, or Tagalog language bi-lingual skills. (D)
7. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications, such as Outlook, Word and Excel. (R)
8. Ability to use a keyboard with moderate speed and a high level of accuracy. (R)
9. Excellent communication skills including the ability to express oneself clearly and concisely when providing service to SCFHP members and providers over the telephone, in person or in writing. (R)
10. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
11. Ability to assume responsibility and exercise good judgment when making decisions within the scope of the position. (R)
12. Ability to maintain confidentiality. (R)
13. Ability to comply with all SCFHP policies and procedures. (R)
14. Ability to perform the job safely with respect to others, to property, and to individual safety. (R)

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to frequent contact with and interruptions by co-workers, supervisors, and plan members or providers in person, by telephone, and by work-related electronic communications.

PHYSICAL REQUIREMENTS

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

1. Mobility Requirements regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)
2. Lifting Requirements regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
3. Visual Requirements ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)
4. Dexterity Requirements regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment; (R)
5. Hearing/Talking Requirements ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
6. Reasoning Requirements ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person and by telephone throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.