Eligibility & Enrollment Supervisor

Position Title:                                    Eligibility & Enrollment Supervisor

Status:                                                 Full-Time / Exempt/Salaried 

Reports:                                             Membership Enrollment Manager

Summary of Duties and Expertise:

The Eligibility & Enrollment Supervisor is responsible for assisting in the development, implementation, and coordination of all activities and functions related to Eligibility and Enrollment at Clinica Monseñor Oscar A. Romero. Supervising the eligibility counselors, ensure quality outcomes, verifying enrollment, and meeting department standards.

Responsibilities:

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  Leading all Eligibility and Enrollment functional, technical, and operational activities;


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  Subject matter expert on Affordable Care Act eligibility and enrollment standards for programs;


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  Reviews enrollment applications of eligibility department ensure quality and compliance;


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  Provides assistance in enrollment process, updating clients, and department on health plans and health programs available;


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  Community liaison for health fairs, stakeholders, and community events;


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  Reviews and maintains tracking system on patient redetermination efforts;


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  Provides weekly and monthly reports on enrollment efforts;


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  Coordinates with the Community Organizing Department on outreach and external efforts;


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  Conduct public education activities to raise awareness about coverage options available under MediCAL, MediCARE, MHLA, CHIP and the Marketplace, amongst others;


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  Screens and enrolls patients under programs they may qualify for, such as all managed care programs, PPO, Medi-Cal, Medicare, and any other commercial health plans available, when possible


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  Provide information and assistance in a fair, accurate, and impartial manner 


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  Provide information and assistance in a manner that is culturally and linguistically appropriate to diverse communities and accessible to individuals with disabilities;


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  Provide referrals to any applicable office of health insurance consumer assistance or ombudsman established under Section 2793 of the PHS Act to address consumer grievances, complaints, or questions about their health plan, coverage, or a determination. 


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  Assist in the training of new personnel.


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  Effective assistance for members and families experiencing difficulties (e.g. enrollment trouble shooting and advocacy on behalf of the family, barriers to enrollment, utilization and retention) and offer retention assistance.

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  Ensure all health center outreach and enrollment assistance workers (i.e., current and  newly supported) comply with and successfully complete all required and applicable federal and/or state consumer assistance training, as is required for all assistance personnel carrying out consumer assistance functions.


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  Must provide timely referrals to other resources, such as the toll-free Marketplace Call Center, or to other state or local entities that can more effectively serve that individual. 


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  Enters and retrieves patient eligibility from computer terminal updating entries as necessary.


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  Demonstrates a positive, can do attitude in responding to employee and patient needs.


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  Attends In-Services and/or Trainings.


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  Coordinate internal audit of enrollment procedures and submissions.


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  Other duties assigned.

Qualifications:

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  Experience in a medical office setting preferred.


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  Certified CEC & MHLA


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  Ability to handle multiple tasks and work in a busy environment.


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  Must have great verbal and written communication skills,


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  English and Spanish is a MUST


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  Able to promote and provide means for a working team relationship with front office, community organizing, and other departments.


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  Able to handle heavy telephone duties and an influx of patients.


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  Organized, flexible, thoroughness, dependability and attention to detail.


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  Must be able to communicate effectively with people of diverse culture, education, social and economic backgrounds.


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  Must have strong team orientation.


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  Able to work and communicate effectively with people of diverse culture, education, social and economic backgrounds.


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  High School Diploma or Equivalent.


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  Must provide proof of up-to-date COVID-19 vaccinations including recommended doses in the primary series AND booster dose when eligible.