Enrollment Specialist (Medi-cal Waiver Team)
Company: San Ysidro Health Center
Location: Chula Vista
Posted on: November 12, 2021
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
- Checks Community Based Care Management program eligibility
- 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
- 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
- Files, uploads, and keeps up to date assigned patient
- Uses various computer systems to obtain information, schedule
appointments, query information, and obtain patient
- 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
- 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
- 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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