Enrollment Specialist I

US-CA-Monterey Park
Job ID
2018-5742
Category
Marketing

Overview

Assist with the eligibility, intake and enrollment process of new patients, clients and participants and thoroughly discusses the patient’s rights prior to enrollment into: Medicare, Medi-Cal, CoveredCA, or other state or local funded programs. Responsible for ensuring the provision of accurate and appropriate screenings/intake of prospective clients, providing information and referrals for P/P/Cs and their families; and identifying new referral sources for all of AltaMed’s programs. Will need to have full understanding of the various programs offered in AltaMed service area, including medical, dental, senior, and care management programs/services. Will act as a bridge between clients and community-based public entities to ensure client needs are met. The Specialist must work as part of a team, concentrating on the delivery of high quality services to all of our customers.

 

Responsibilities

  1. Adherence to all Call Center and AltaMed policies and procedures.
  2. Ability to efficiently and accurately schedule, reschedule and/or cancel appointments for certified enrollment counselor/patient care coordinator and health care advisors as requested by the patient/client and in accordance with AltaMed’s Appointment Scheduling Policy.
  3. Routinely check the queue to monitor number of calls on hold.
  4. Answer all incoming calls and properly dispose of calls via appropriate transfer, message taking, or follow-up and return call.
  5. Relay patient questions, requests and other calls to the appropriate person/department.
  6. Effectively and proactively manage call volume as required to reduce and maintain average time to answer and abandoned rate at the established goal.
  7. Assist prospective clients with intake and eligibility for various AltaMed programs; must be cross-trained to fully understand and be able to collaborate with Marketing and Operation staff to streamline enrollment process.
  8. From proper screening, produce self-generated leads to support membership growth to AltaMed programs by properly screening for all programs, such as Medicare, Medi-Cal, CoveredCA, and Commercial.
  9. Adherence to strict State, Federal, and DHS regulations and policies regarding marketing practices for senior services and Medi-Cal managed care products. (PCC)
  10. Build and maintain relationships with key staff in priority sites to build patient referral mechanisms and promote Patient Navigation service.
  11. Educate members/participants about their rights and responsibilities.
  12. Assist patients/clients in selecting and/or changing their primary care provider/health plan.
  13. As part of an multidisciplinary team, outbound to members who have dis-enrolled or transferred out from AltaMed to try to get them to come back to the AltaMed program.
  14. Explain the benefits of the health care programs and how to utilize health plan benefits.
  15. Will maintain and report accurate daily/weekly/monthly statistical records to track all individual productivity through the implemented department systems, such as: CRM database, NextGen Electronic Medical Record, ININ phone system, and spreadsheets.
  16. Intake calls to program/service referral conversion rates must meet established goals.
  17. Develop and maintain outstanding relationships with referral sources within service area and within other community agencies.
  18. Maintain well informed on services and programs offered by AltaMed by maintaining in file updated marketing collateral and program brochures.
  19. Refer non-qualifying prospective clients to appropriate agencies for further assistance.
  20. Must complete training and become subject matter expert on State and local (Los Angeles and Orange County) health coverage options (i.e. Medicare, CoveredCA, Medi-Cal, and other local city programs) and complete grant/department required trainings.
  21. Will use NextGen Practice Management to input and schedule medical appointments completely and accurately. It may include update patient contact information.
  22. Must complete the PACE Marketing training program and achieve a 90% or better score on the State DHS Marketing Representative Examination.
  23. Participate in various (job related) meetings and trainings as assigned.
  24. Assist with the review/development of Community Access Point (CAP) policies & procedures to instill continuous quality improvement.

Qualifications

  1. High School Diploma or GED Certificate
  2. Minimum of 2 years of experience in Telesales in the healthcare industry required.
  3. Certified Enrollment Counselor (CEC), preferred.
  4. Complete the CEC training and certification within 2 months of employment.
  5. Complete the PACE Marketing training program and achieve a 90% or better score on the State DHS Marketing Representative Examination.
  6. Bilingual: Spanish/English required.

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