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Enrollment Specialist (Medi-cal Waiver Team)

Company: San Ysidro Health Center
Location: Chula Vista
Posted on: November 12, 2021

Job Description:

Position Summary: As a member of the Home and Community Based Alternatives (HCBA) Medi-Cal Waiver Team, reporting to the HCBA Medi-Cal Waiver Enrollment Specialist Supervisor, the Enrollment Specialist is responsible for assisting HCBA Care Management Teams (CMT's) with timely application processing, accurate documentation of case status through enrollment, and follow up of Care Management documentation, to ensure patient retention and engagement in the in accordance with the Community Based Care Management program. The Enrollment Specialist should have excellent time management and communication skills, as he/she will collaborate with patients, family members/caregivers, internal teams, and external teams to deliver results. Essential Functions of the Job:

  • Answering phones.
  • Receives notification of interest for Community Based Care Management program enrollment from Toll-Free number, Transition of Care documentation, referral form, fax line, e-mail, mail, and/or external facilities.
  • Checks Community Based Care Management program eligibility requirements.
  • Electronic and/or physical filing, and organize files including copying and scanning.
  • Conducts Care Management programs eligibility screening, intake, education and enrollment assistance activities to initially determine participant needs and eligibility for enrollment.
  • Tracks, monitors, and reviews program availability or waitlist status for potential participants.
  • Assigns a Care Management Team to the potential participant, schedules the initial assessment, and keeps track of upcoming appointments.
  • Requests/receives participant records from Primary Care Provider (PCP) or works with the potential participant or their circle of support to establish a PCP.
  • Requests/receives participant documentation from DHCS.
  • Obtains Community Based Care Management program documentation from DHCS via phone, writing, or electronic media. In addition, follows-up on missing documentation to obtain enrollment approval or scheduling when appropriate.
  • Responds to inquiries as to current status of authorization by assessing the request and evaluating the circumstances to provide the correct information.
  • Reviews, tracks, and monitor Medi-Cal and Community Based Care Management program continued eligibility for enrolled patients and service providers.
  • Files, uploads, and keeps up to date assigned patient files.
  • Uses various computer systems to obtain information, schedule appointments, query information, and obtain patient documentation.
  • Provides data entry and report generation as needed.
  • Maintains and collects and data from referral, intake, enrollment, marketing and outreach activities and submits pertinent reports by due dates.
  • Comply with SY Health, DHCS HCBA Waiver and/or Patient Engagement Departmental regulations and complete trainings as required.
  • Participates in any HCBA Medi-Cal Waiver Department related meetings and activities as required.
  • Collaborate with other Patient Engagement departments and participate in year around community events, if necessary. Additional Duties and Responsibilities:
    • Keep all activities in line with the core values and contribute to the positive culture of SY Health.
    • Represent SY Health in an effective and professional manner and maintains positive working relationships with the general public, clients, patients, co-workers and other agencies.
    • Adheres to SYHealth and all department's policies and procedure protocols.
    • Maintains established departmental policies and procedures, objectives quality assurance programs, safely, environmental and infection control standards.
    • Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops.
    • Performs other related duties/projects as assigned or requested. Job Requirements: Education Required (Minimum level of education): High school diploma or GED equivalent. Preferred: Associates Degree (or greater) in Health Care Administration or Medical Assistant Certificate or Business Office Administration Certificate Certifications/Licenses Required: CA driver's license with appropriate insurance coverage Experience Required (Minimum level of experience): 1 year experience in healthcare setting in any of the following:
      • Front or back office
      • Referral authorization
      • Health Care Administration, including knowledge of programs and health plans eligibility and guidelines. Verbal and Written Skills Required to Perform the Job: Good verbal and written communication skills. Technical Knowledge and Skills Required to Perform the Job: Medical terminology and basic computer. Typing of 35 wpm. Ability to handle multiple activities simultaneously. Be attentive to patient needs and concerns. Willing to work with others as a team member. Equipment Used: Work laptop, Excel spreadsheets, Outlook program, Nextgen, FAX, additional software, as required. Working Conditions and Physical Requirements: Prolonged sitting position, walking, constant telephone communication. May be required to work evenings and/or weekends. About Us San Ysidro Health is a Federally Qualified Health Care organization committed to providing high quality, compassionate, accessible and affordable healthcare services for the entire family. The organization was founded by seven women in search of medical services for their families and community. Almost 50 years later, San Ysidro Health now provides innovative care to over 108,000 patients through a vast and integrated network of 47 program sites across the county. San Ysidro Health could not serve our patients without the dedication of our passionate and hardworking employees. Apply today and become a part of our mission-driven team! San Ysidro Health has a long-standing commitment to equal employment opportunity for all applicants for employment. Employment decisions including, but not limited to, those such as employee selection, performance evaluation, administration of benefits, working conditions, employee programs, transfers, position changes, training, disciplinary action, compensation, and separations are made without regard to reace, color, religion (including religious dress and grooming), creed, national origin, nationality, citizenship status, domestic partnership status, ancestry, gender, affectional or sexual orientation, gender identity or expression, marital status, civil union status, family status, age, mental or physical disability (including AIDS or HIV-related status), atypical heredity cellular or blood trait of an individual, genetic information or refusal to submit to a genetic test or make available the results of a genetic test, military status, veteran status, or any other characteristic protected by applicable federal, state, or local laws. Other details
        • Pay Type Hourly Apply Now
          • 1800 Maxwell Rd, Chula Vista, CA 91911, USA

Keywords: San Ysidro Health Center, Chula Vista , Enrollment Specialist (Medi-cal Waiver Team), Other , Chula Vista, California

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