Outreach and Enrollment Worker

Job Details Job Title Outreach and Enrollment Reports To Supervisor of Patient Services Salary Grade N8 FLSA Status Non-Exempt Effective Date November 2023 Summary The Outreach and Enrollment worker provides education and health plan coverage resource information for patients and the health center community who lack access to health care and health insurance.
They provide enrollment assistance, within the health center and deploy into the community, collect required information, and submit all necessary documentation to apply for health insurance benefits and/or programs.
They build relationships with local partner organizations and contracted payers to provide health insurance coverage and access to quality medical, dental, psychiatric, behavioral and specialty care.
Patient, county service provider or managed care plan follow-up is completed to ensure they have all the necessary documentation needed for the review.
This position will keep track of patients/client applications, approved insurance benefits related to redetermination, renewals, and if warranted, request an appeal of denials.
This position also monitors contracted health plan patient rosters, collaborates, and participates in workgroups related to their role.
Essential Functions Provide enrollment assistance (including but not limited to completing coverage applications, gathering required documentation and troubleshooting the enrollment process) for the uninsured to access subsidized, low-cost and free health insurance programs through Medi-Cal and other managed care plans to increase patient access to health care.
Uses strong customer service skills to perform outreach, meets and/or distributes materials to patients, community members, partner organizations and businesses to build coverage option awareness.
Determines an individual's eligibility for appropriate programs with a focus on health insurance for billing reimbursement and assess their income and educates them on how to access and utilize those services including food stamps, housing, and transportation.
Verifies insurance benefits and eligibility by using insurance portals or telephone.
Submit applications for patients and their families for qualified health insurance benefits and schedule follow-up appointments/phone calls with patients and case workers to assure accountability.
Work to create a positive working relationship with county eligibility workers and managed care plan representatives.
Create and maintain a contact list with phone, fax and email information.
· Determines an individual's eligibility and assists them in maintaining eligibility for appropriate programs with a focus on health insurance.
Organization/Time management skills Experience working with individuals and/or families experiencing homelessness and case management experience or similar experience.
Provide monthly outreach events in or around the health center vicinity.
Downloads contracted payer patient rosters monthly and reflects that information on patient accounts to ensure accuracy of referrals and billing.
Collaborates and participates in internal and external health plan meetings and workgroups to stay informed of changes and implement new policies and/or workflows to adhere to state and federal guidelines.
Crosstrain and cover for Patient Service Representative as needed.
On time completion of assigned training and policies Performs other duties as assigned.
On time completion of assigned training and policies.
Performs other duties as assigned.
Qualifications High School Diploma or GED Bilingual (Spanish/English) written, and verbal required.
Intermediate knowledge of Medi-Cal, Medicare, Managed Care Plans, Marketplace Plans, Cal Fresh, Private Insurance and insurance guidelines.
1 year of experience verifying insurance/program eligibility and benefits required Excellent customer service skills and commitment to providing the highest level of customer satisfaction.
Professional or personal experience supporting individuals with disabilities, mental illnesses, or challenging behaviors highly preferred Ability to work independently and coordinate multiple tasks.
Ability to interface with all levels of personnel in a professional manner.
Minimum 1 year experience in a healthcare setting.
Equivalent combination of education and experience that provides the skills, knowledge, and ability to perform the essential job duties - Certified Enrollment Counselor Certification must be obtained within 90 days of hire and maintained while in this position.
About Father Joe’s Villages At Father Joe’s Villages, we are looking for compassionate, mission-driven individuals to join our team and help us end homelessness one life at a time.
Our work is driven by our C.
R.
E.
E.
D which is the foundation for our interactions with clients, volunteers, other staff members and the community at large: Our Values Compassion-Concern for others and the desire to assist.
Respect-An act of giving particular or special regard.
Empathy-Understanding and being aware of and sensitive to the feelings, thoughts, and the experience of others without judgment.
Empowerment-Helping others to help themselves.
Dignity-All people are considered worthy of our esteem.