Salary Range: $16.94 to $22.92 Hourly

Summary:

Under the direct supervision of the Director of Managed Care Services, the Managed Care Enrollment Coordinator is responsible for coordinating and implementing member’s enrollment into Managed Care Health Plans and selection of Primary Care Physician, transfers of plans and providers, eligibility verification, information and education for patients. Prepares monthly reports, detailing enrollment for the current month and performs plan relations and other duties as assigned.

DUTIES AND RESPONSIBILITIES:

• Responsible for receiving patients and public in a professional and courteous manner.
• Responsible for verification of Health Plan status (eligibility) for new and established patients.
• Responsible for assisting patients and their families with plan and provider transfers and maintaining data about those assisted.
• Responsible for providing patients with information and education on Medi-Cal, Medicare and Covered CA Managed Care options and on the health plan enrollment process.
• Responsible for referring patients to the Department of Public Social Services Worker(s) as needed.
• Responsible for assisting Medi-Cal, Medicare Advantage, AIM and Covered CA patients with enrolling into health plan coverage.
• Responsible to assist consumers with disenrollment or Requests for Medi-Cal Exemptions when necessary, per patient’s choice and maintain data on said assistance.
• Responsible for scheduling appointments for Managed Care patients to assist with applications and update patient registration information needed.
• Responsible for entering notes and alerts in the EHR Practice Management system for Managed Care patient changes, each time a change is made.
• Responsible for follow-up on courtesy visits of Managed Care patients to ensure completion of transfer.
• Responsible for maintaining data on the number of new and established patients (detailed in Monthly Enrollment Report).
• Responsible for reporting data on Medi-Cal and Managed Care enrollments and disenrollments on a monthly basis.
• Responsible for maintaining New Patient Database for Initial Health Assessments (IHA), schedule IHA appointments for new patients, survey and follow up on show rates for IHA compliance.
• Responsible for handling telephone calls to and from patients, health plans, IPA and Health Care Options regarding managed care issues, in a timely and effective manner, and logging information on telephone interactions.
• Responsible for maintaining efficient flow of Managed Care patients.
• Responsible for accurately documenting all Managed Care enrollment forms.
• Responsible for assisting patients with maintaining active status in their current Managed Care Plan, including Re-determination and on-hold status follow up.
• Responsible for initiating solutions when a Managed Care problem arises for patients who wish to be seen at Arroyo Vista.
• Responsible for communicating problems/concerns/solutions when necessary to the appropriate staff members.
• Responsible for an understanding of the Managed Care and Patient Enrollment Coordinator Manual.
• Responsible for following all Agency safety and health standards, regulations, procedures, policies, and practices.
• Actively participates in the Quality Management Program, Safety Program, Emergency Preparedness and Infection Control Programs.
• Responsible for attending trainings and seminars regarding Managed Care plans accepted at Arroyo Vista.
• Responsible to take such steps necessary to allow Arroyo Vista to realize the benefits of the Electronic Health Records system including the adoption, implementation, upgrading and meaningful use of such technology as requested or required by Arroyo Vista or other federal or state authority.
• Performs other duties as assigned.

REQUIREMENTS:

• Associates Degree and one year Managed Care Enrollment experience, or 2-4 years’ experience in the health care field.
• Bilingual (English/Spanish).
• Two years experience with customer service and satisfactory written, telephone, and verbal communication skills.
• Computer literate in health information system(s) and Microsoft Office applications with ability to type 35 WPM.
• Effective verbal and written communication skills with ability to be thorough, accurate, and detail oriented.
• Reliable transportation with the ability to get to other locations as required to perform the functions of the position.
• Experience in Managed Care Enrollment, Medical Front/Back Office and/or Financial Screening preferred.
• Ability to work well with others in a professional team oriented environment.
• Complete Certified Application Assistant (CAA) certification, within first month of hire.

Job Type: Full-time

Pay: $16.94 - $22.92 per hour

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Clinic
• JCAHO accredited facility

Work Location: One location

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