Healthcare Coverage & Enrollment Specialist

OHI - Ocean Health Initiatives, Inc.; Toms River (NJ); On-site; USD 42,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

401(k) Match

Paid Time Off

Paid Holidays

Employee Assistance Program

Employee Discounts

Employee Referral Program

Job summary

OHI - Ocean Health Initiatives, Inc. is seeking a Patient Coverage & Support Specialist to help patients obtain and maintain healthcare coverage through education, outreach, renewal and application assistance, and ongoing follow-up.

The Specialist will manage MCO reports, work with patients, health plans, and internal teams to resolve coverage barriers and prevent gaps in coverage, while supporting registration, outreach events, and enrollment activities in New Jersey.

Qualifications

• High school diploma or equivalent is required.
• Patient centered service; Professional verbal and written communication; ability to explain coverage requirements clearly; strong organization, documentation, follow-up, and worklist management; confidentiality are required.
• Microsoft Office 365 proficiency is required.
• Ability to travel to OHI sites and community outreach locations required.
• Medicaid and insurance literacy; outreach and engagement; registration accuracy; application and document support; consistent follow-up; attention to detail; problem solving and escalation; collaboration and accountability; confidentiality and compliance is required.
• One to three years in patient access, registration, healthcare eligibility, Medicaid enrollment, financial screening, insurance verification, community outreach, or a related healthcare setting are preferred.
• Electronic medical record experience and knowledge of Medicaid renewals, managed care, and public coverage programs are preferred.
• Obtain and maintain the certification and authorization required for assigned enrollment duties, including renewal training and continuing program requirements.

Responsibilities

• Review renewal and redetermination worklists; identify patients approaching deadlines or at risk of losing coverage. Contact patients by telephone and other approved methods, with repeat follow-up as needed.
• Explain Medicaid notices, renewal requirements, deadlines, eligibility processes, and required documents in clear, patient-friendly language.
• Help patients complete Medicaid renewals and eligibility and Presumptive Eligibility applications within required training, certification, and authorization. Schedule and conduct enrollment appointments; assist patients with completing and submitting ACA Marketplace applications, required documentation, and follow-up.
• Help patients gather and submit documents, address incomplete applications and verification requests, and track next steps until resolved, appropriately transferred, or closed under established procedures.
• Explain coverage options without directing patients toward a specific plan unless authorized. Refer or elevate complex issues and assistance outside the role’s scope to the appropriate leader, agency, MCO, or certified resource.
• Review and complete assigned MCO eligibility, renewal, redetermination, termination, and outreach reports within established timeframes. Research each listed patient, conduct outreach, and document the disposition.
• Communicate with MCO representatives about eligibility, discrepancies, renewal concerns, and unresolved cases, consistent with privacy and authorization requirements.
• Maintain organized, accurate, audit-ready records of reports reviewed, contact attempts, patient responses, education, application assistance, documents, barriers, referrals, escalations, and outcomes.
• Keep tracking tools aligned with report status. Enter information in Athenahealth, payer portals, enrollment systems, spreadsheets, Monday.com, and other approved systems as assigned.
• Meet productivity, quality, and outcome expectations; complete required reporting and alert leadership to unresolved cases, coverage risks, recurring barriers, and workflow improvement opportunities.

Skills

Communication

Organization

Attention to detail

Confidentiality

Problem solving

Bilingual English/Spanish (preferred)

Travel readiness

Tools

Microsoft Office 365

Job description

OHI - Ocean Health Initiatives, Inc. is seeking a Patient Coverage & Support Specialist to help patients obtain and maintain healthcare coverage through education, outreach, renewal and application assistance, and ongoing follow-up.

The Specialist will manage MCO reports, work with patients, health plans, and internal teams to resolve coverage barriers and prevent gaps in coverage, while supporting registration, outreach events, and enrollment activities in New Jersey.