Position Summary:
As a member of the Home and Community Based Alternatives (HCBA) Medi-Cal Waiver Team, reporting to the HCBA Medi-Cal Waiver Program Supervisor, the Enrollment Specialist is responsible for assisting HCBA Care Management Teams (CMT’s) with timely application processing, accurate documentation of case status through applicant enrollment, and follow up of Care Management documentation, to ensure participant retention and engagement in accordance with the HCBA Medi-Cal Waiver program. The Enrollment Specialist is responsible for assisting HCBA Care Management Teams (CMT’s) and Referrals Coordinator with the enrollment of Waiver Personal Care Providers (Individual Providers) and HCBA Waiver service providers, such as Public Authority (PA), In Home Support Services (IHSS), Department of Health Care Services (DHCS) Waiver Personal Care Services (WPCS) Unit, Home Health Agencies (HHA), Personal Care Agencies (PCA) and Independent Nurse Providers (INP). The Enrollment Specialist is the primary liaison between potential beneficiaries, potential new service providers and the HCBA Waiver Program.
The Enrollment Specialist should have excellent time management and communication skills, as he/she will create and deliver educational materials for medical providers and other community resources via presentations, collaborate with clients, family members/caregivers, service providers, internal and external teams to deliver enrollment results.
Essential Functions of the Job:
- Receives notification of interest for HCBA Medi-Cal Waiver program enrollment from Toll-Free number, Transition of Care documentation, referral form, fax line, e-mail, mail, and/or external facilities.
- Answer/Return phone calls in a prompt, professional and courteous manner.
- Checks HCBA Medi-Cal Waiver program eligibility requirements for applicants, including Medi-Cal insurance eligibility.
- Conducts Care Management programs eligibility screening, intake, education, and enrollment assistance activities to initially determine participant needs and eligibility for enrollment.
- Ensuring that HCBA Waiver applications are completed correctly and that the required supporting materials have been provided.
- Participates in outreach events and community activities in conjunction with and as assigned by the Program Supervisor and/or Program Manager.
- Participates in outreach virtual/in-person presentations with different organizations to share the HCBA Waiver Program.
- Manage the HCBA Waiver program information by presenting information, utilizing available media, group presentations, mailing and others.
- Tracks, monitors, and reviews program availability or waitlist status for potential participants.
- Assigns a Care Management Team to the potential participants, 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.
- Obtains Community Based Care Management program documentation from DHCS, CMTs, San Diego County and other organizations via phone, writing, or electronic media. In addition, follows-up on missing documentation to obtain case 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 client’s 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 data from referral, intake, enrollment, marketing, and outreach activities and submits pertinent reports by due dates.
- Review, track and process State of California, DHCS Waiver Personal Care Services (WPCS) provider agreements.
- Assist HCBA Waiver families and providers with the completion of the WPCS agreement to enroll the provider in the participant’s care team.
- Assist the Referrals Coordinator in reviewing, tracking, and processing the WPCS Authorization forms as needed.
- Participates and leads program presentation for potential HCBA Waiver Providers.
- Utilize knowledge & skills set to accurately complete Medi-Cal HCBA Waiver Provider enrollment application packets for Home Health Agencies, Personal Care Agencies, Independent nursing providers and others.
- Maintain meaningful relationships with new and existing service providers.
- Enter, maintain, review, respond and update provider applications and contracts into credentialing databases in conjunction with SYH Contract Department.
- Assist the Referrals Coordinator reviewing, tracking and processing the Treatment Authorization request from HCBA Waiver Providers (HHA, PCA and INP) as needed.
- 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 and San Ysidro Health departments and participate in year around community events, if necessary.
- Electronic and/or physical filing and organize files including copying and scanning.
- Files, uploads, and keeps up to date assigned patient files.
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, coworkers 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.
- Create and implement training programs to address participant and provider enrollment.
- Performs other related duties/projects as assigned or requested.
Job Requirements
Education Required:
High School Diploma or GED
Certifications/Licenses Required:
Reliable transportation to get to and from work as well as to Outreach and other enrollment events.
Experience and Required Skills:
1 year of experience in healthcare setting in any of the following:
- Front or back office
- Referral authorization
- Healthcare Administration, including knowledge of programs and health plan eligibility and guidelines
An Associate Degree or higher level of education in Healthcare Administration or a Medical Assistant or Business Office Administration Certificate will be considered in lieu of experience.
Verbal and Written Skills Required to Perform the job:
Good verbal and written communication skills.
Equipment Used:
Computers, phones, copy and fax machines, and additional software as required.
Working Conditions and Physical Requirements:
Prolonged sitting, walking, constant telephone communication.
Universal Requirements:
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.
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 race, 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.
