Enrollment Specialist

DEPARTMENT:Patient Financial Services
REPORTS TO: Enrollment Specialist Supervisor
LOCATION: Huron and Lemoore
 
SUMMARY:
Enrollment Specialist plays an important role in helping children and families enroll in the Medi-Cal Program. In addition to helping families complete and submit the online applications, Enrollment Specialists also keep families informed about program changes and help them maintain their health coverage. They also help families who do not qualify for the Medi-Cal Program by referring them to other available programs. Additional when not performing enrollments, the position is responsible for the efficient and effective scheduling of site appointments. Answer incoming telephone calls from patients and physician offices calling to schedule Medical, Dental, CPSP, Behavioral Health and Health Education appointments. Plans, organizes, monitors and reports as necessary. Confirms appointments per established protocol. Secures patient information for charting, billing and record keeping purposes. Ensures that established information is obtained in order to pre-register patients.
 
SUMMARY OF RESPONSIBILITIES:
This non-exempt position is part of the Call Center position designation and is directly responsible for supporting the sites by improving UHC’s revenue cycle through new enrollments and recertification’s, monitoring errors, and correcting issues. The Enrollment Specialist works closely with the Enrollment Specialist Supervisor to this end and is familiar with the screening and evaluative processes necessary to determine a patient’s eligibility for Medi-cal, (including Medi-cal Dental and presumptive eligibility), Family PACT, CDP & Healthy Families.
 
· Assist applicants in properly completing the application. Answer questions.
· Ensure the confidentiality of all applications, records, and any information received in written, graphic, oral, or other tangible forms.
· Review and explain the documents that are required with the application.
· Refer applicants, when necessary, to the county Department of Social Services (DSS) for Medi-Cal if they need more information or assistance with complex issues or other programs
· Assist applicants in estimating their monthly premiums.
· Overall knowledge of the revenue cycle process, registration, insurance verification, precertification, billing compliance, payer contracts, patient estimation, financial assistance.
· Schedules, educates, registers, verifies and estimates services for the patient, updates insurance and demographic information.
· Answers incoming calls on a multi-line phone.
· Makes outbound calls to confirm and obtain pre-registration information.
· Promptly and courteously answers and screens phone calls for the department; routes call as appropriate within established customer service guidelines; accurately records messages and delivers to the appropriate party in a timely manner; checks voicemail frequently.
· Providing outstanding customer service to internal and external customers
· Reporting any potential customer concerns or complaints immediately to management
 
1. PERFORMANCE AREA 1: Enrollment Process
a) Ensures the quality of work for their area is error-free and complete. This is done by conducting regular audits of staff work and process review.
b) Effectively interfaces with billing department and front office operations on issues related to revenue and billing processes.
c) Supports the functions of front office by ensuring that collection and data entry of patient information.
d) Supports the front office functions by ensuring that any corrections are resolved in a timely manner and at the front support level to ensure timely reimbursement.
e) Effectively communicates issues and eligibility and billing concerns to HCA Supervisor and Director of Special Projects when they arise.
f) Maintains direct communication with Director of Special Projects, providing updates on patient enrollment and eligibility status.
g) Supports the work of the area by being able to multitask and manage multiple assigned projects and meet assigned deadlines.
 
2. PERFORMANCE AREA 2: General Corporate Expectations
a) Attends and actively participates in all meetings (e.g., department meetings, program meetings, employee staff meetings) and other activities as required or assigned.
b) Attends workshops/seminars as necessary to increase skills and knowledge to provide effective care, treatment, and/or leadership.
c) Supports the overall needs of the health center by working flexible or extended hours when necessary.
d) Displays a positive, professional and respectful demeanor at all times toward employees, peers, professional contacts, and patients served, maintaining a professional appearance and positive image for the health centers.
e) Contributes to the team by promoting positive staff interaction, maintains open communication with other programs/departments.
f) Supports the needs of the health center by traveling to other health centers when staffing needs dictate.
g) Demonstrates awareness of, and compliance with, organizational mission and objective of UHC to provide health care access and support services for all members of the community.
h) Supports their own staff development by completing the required hours of continuing education each year.
i) Other work-related duties as assigned by supervisor. Duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.
j) Maintains confidentiality and respect for information regarding patients and other team members; abides by UHC Rules of Confidentiality and general HIPAA regulations regarding privacy.
 
QUALIFICATION REQUIREMENTS
 
EDUCATION AND LICENSE/CERTIFICATION:
· Certified Application Assistant (CAA) required.
· High School Graduate or equivalent.
· Knowledge of billing processes and coding preferred.
 
PRIOR EXPERIENCE:
· Minimum 2 years of experience in a health center setting as Healthcare Associate and/or certified application assistant.
· Demonstration of strong understanding of patient billing, front office processes and patient intake.
 
SKILLS
 
· Bilingual (English/Spanish)
· Able to quickly build and maintain rapport with peers, patients and providers; team player
· Customer-service oriented
· Positive professional insight
· Flexibility and dependability
· Demonstrated good problem-solving skills; sound judgment
· Effective leadership/supervisory skills
· Modern office practices and procedures including email, strong computer skills
· Attention to detail and excellent follow-through on work tasks
· Able to handle multiple tasks simultaneously
 
PHYSICAL REQUIREMENTS
· Must be able to lift up to 20 pounds and push up to 50 pounds (on wheels).
· Must be able to hear staff on the phone and those who are served in-person, and speak clearly in order to communicate information to patients and staff.
· Must be able to read memos, computer screens, personnel forms and clinical and administrative documents.
· Must have high manual dexterity.
· Must be able to reach above the shoulder level to work, must be able to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn
 
ADDITIONAL JOB INFORMATION:
Must be available to work non-standard hours and overtime based on work volume. Hours of operation are 8:00AM to 8:00 PM, schedules may vary. Successful applicants must be flexible with their start and end times, as work hours will be based on the business needs of our internal and external customers. Applicants will be required to rotate and work a variety of shifts.