Job Description

The Enrollment Specialist I will assist in maintaining Medi-Cal membership and process basic functions of the Enrollment Unit. This position will review, research, and resolve Medi-Cal eligibility issues and systems related errors as well as primary care physician (PCP) assignment failures within established production and quality standards. Completes and processes reports and appropriately documents member records of actions taken to correct or update member records, PCP assignments etc. Processes reports to ensure primary care assignment is appropriate, processes certain authorized representative forms and document members records appropriately. Reports eligibility discrepancies and deceased members to appropriate counties and adds newborn records upon request and after verification of eligibility.

Responsibilities

• Processes PCP assignments and reports.
• Reviews and responds to eligibility questions and issues.
• Processes a variety of membership reports to ensure members records as well as PCP assignments are appropriate.
• Monitors the E-Unit inbox and processes all Medi-Cal eligibility related questions and requests.
• Maintains and processes out of area requests.
• Processes all related newborn add requests etc.
• Participates in special projects, tasks, and assignments, as needed.
• Processes duplicates records.
• Communicates with county contacts to correct membership records, aid codes or other eligibility discrepancies at the county level.
• Arranges face to face interpreting and reconciles invoices.
• Processes “no show” appointment requests.

Secondary Duties and Responsibilities

• Supports and assists team members in their daily duties as needed
• Other duties as assigned

Qualifications

Education and Experience

High School Diploma or equivalent; one (1) year experience in health care or Medi-Cal or Medicaid eligibility. Customer service experience preferred.

Special Skills, Licenses and Certifications

Thorough knowledge of managed care and Member Services Policies and Enrollment Unit procedures. Excellent understanding of all Partnership policies and procedures relating to all aspects of care. Excellent understanding of external agencies that provide services to Partnership members. Strong understanding about the Medi-Cal eligibility process. Working knowledge of business software applications. Proficient use of computer keyboard to access data. Bilingual skills in Spanish, Tagalog, or Russian are preferred.

Performance Based Competencies

Effective written communication skills. Excellent organization skills with ability to prioritize assignments and meet deadlines. Ability to use good judgment within the scope of authority and to handle confidential and sensitive issues with tact and diplomacy. Ability to stay focused on repetitive work and meet production and quality standards. Ability to understand and follow instructions. Must have excellent organization skills and be detail oriented with a high level of accuracy.

Work Environment And Physical Demands

More than 90% of work time is spent in front of a computer monitor. When required, the ability to lift, carry, or move objects of varying size, weighing up to 10 lbs. Ability to use multiple computer monitors, headsets, and keyboard to accomplish tasks.

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE

$30.00/hour

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.