Enrollment Specialist

The Enrollment Specialist connects Gracelight Community Health (“Gracelight”) patients with health coverage. Working within Gracelight’s health centers, the Enrollment Specialist helps existing patients obtain and maintain coverage through annual renewals and redeterminations for county, state, and federal programs, including Medi-Cal, Covered California, and Medicare, and assists new patients with enrollment, primarily in the clinic by referral from care teams and front-office staff. The Enrollment Specialist helps patients resolve coverage problems and access barriers, promotes coverage utilization and retention, and may occasionally represent Gracelight at community events. ESSENTIAL JOB DUTIES AND RESPONSIBILITIES : Conducts renewal and retention outreach for Gracelight’s existing patient base, including contacting patients at annual renewal to offer re-enrollment assistance and performing outbound calls to patients due for redetermination and to patients aging into Medicare. Assists new patients with health coverage enrollment, primarily in the clinic upon referral from care teams and front-office staff. Conducts intakes by phone and in person to determine immediate healthcare needs and connects patients to appropriate resources; refers patients to community programs according to their needs. Assists eligible individuals and families with completing and submitting health insurance applications, including gathering necessary documents and resolving problems; provides program information in a fair, accurate, and impartial manner. Processes applications through CalHEERS and other web-based enrollment systems; reviews paper and electronic applications for completeness and accuracy. Maintains Certified Enrollment Counselor (CEC) certification for access to CalHEERS and Covered California systems; wears the assigned Covered California badge when enrolling or disseminating Covered California information. Maintains current expertise in eligibility, enrollment, and program specifics for county, state, and federal programs, including Medi-Cal, Covered California, and Medicare; attends monthly and periodic trainings to stay current on program updates. Provides education and support on coverage utilization, plan benefits, and maintaining coverage; acts as liaison with coverage programs when problems arise; tracks all applications and assists patients with appeals when appropriate. Assists patients with MyChart registration. Completes data tracking, monthly reports, and client file documentation routinely. May occasionally support community outreach events, such as health fairs or enrollment events, as assigned. Maintains compliance with all applicable federal, state, and local regulations, HRSA Health Center Program requirements, and Gracelight policies and procedures. Works at any Gracelight location as needed, is available to work all business hours, including evenings and weekends, and performs other duties as assigned. QUALIFICATIONS, SKILLS AND ABILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Lived experience in the communities served and/or one (1) year of direct service experience in a healthcare, enrollment, or community-based setting required. Must obtain and maintain Covered California Certified Enrollment Counselor (CEC) certification. Bilingual English/Spanish required. Ability to read and interpret policies, procedures, and program materials; compose routine reports and correspondence; perform basic math calculations; and use Microsoft Word, Excel, PowerPoint, and Outlook proficiently. Excellent oral and written communication skills; ability to interact appropriately with diverse populations and community groups with multicultural sensitivity; and ability to organize, prioritize, and follow work through to completion with minimal supervision. Flexibility to work at any/all Gracelight locations required, with occasional work at community events. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION/EXPERIENCE: High School diploma or equivalency certificate required. Ability to learn about and understand state and county programs such as Medi-Cal, Covered CA (Affordable Care act) and other health insurance programs required. A valid CEC certification, requiring annual renewal (QHC will sponsor upon hiring) Successfully pass the Live Scan background check for a CEC. Sales/Marketing and public speaking and presentation experience preferred. LANGUAGE SKILLS: Ability to read and interpret documents, such as policies and procedures, benefits information, benefit surveys, board minutes, routine mail, simple contracts, and procedure manuals. Ability to compose routine reports and correspondence. Ability to speak effectively with employees, visitors and management. MATHEMATICAL SKILLS: Ability to calculate figures and basic math. REASONING ABILITY: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to apply common sense to daily situations that arise. Ability to make decisions and execute to produce a positive outcome. OTHER SKILLS AND ABILITIES: Exercise good judgment. Ability to identify and access appropriate community resources and work with of community leaders. Familiarity with multicultural settings and sensitivity to multicultural issues. Self-starter, able to take initiative and provide input for decision-making. Computer literate. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to finger, handle or feel and reach with hands and arms. The employee frequently is required to stand, walk, and sit. The employee is occasionally required to climb or balance, stoop, kneel, crouch or sit. The employee must frequently lift and/or move up to 10 pounds and occasionally life and/or move up to 30 pounds. The employee is occasionally required to ascend and descend one flight of stairs. Specific vision abilities required by the job include close vision, color vision, and ability to adjust focus. WORK ENVIRONMENT : The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is often low. However, there are many times when there is a high ambient background noise of phones and multiple conversations. Must be able to screen out the background noise to concentrate on the work at hand.