Managed Care Enrollment Coordinator

Arroyo Vista Family Health Center; Los Angeles (CA); On-site; USD 40,000 - 65,000; Full time

Job summary

An established industry player is seeking a Managed Care Enrollment Coordinator to enhance patient services and support enrollment into Managed Care Plans. This entry-level role involves coordinating with patients, assisting with health coverage navigation, and ensuring compliance with regulatory standards. The successful candidate will engage with diverse populations, maintain accurate records, and facilitate appointments using health information systems. Join a dedicated team committed to improving healthcare access and outcomes in the community. If you have a passion for helping others and possess strong communication skills, this position is an excellent opportunity to make a difference.

Qualifications

• Associate's Degree and 1 year experience in Managed Care Enrollment.
• Bilingual in English and Spanish is preferred.

Responsibilities

• Provide enabling services for patient enrollment into Managed Care.
• Assist patients with enrollment and maintain data records.

Skills

Managed Care Enrollment

Customer Service

Communication Skills

Bilingual (English and Spanish)

Health Information Systems

Education

Associate's Degree

Tools

Microsoft Office

Electronic Health Records (EHR)

BenefitsCal

Covered CA

Job description

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Summary

Under the supervision of the Director of Managed Care Services, the Managed Care Enrollment Coordinator implements patient enabling services, including enrollment into Managed Care Plans (MCPs), selection of Primary Care Physicians (PCPs), transfers, eligibility verification, and health care coverage navigation. The coordinator schedules Initial Health Assessments for new enrollees, surveys disenrolled patients for coverage and retention strategies, and validates monthly eligibility reports from contracted organizations.

Duties and Responsibilities

1. Provide enabling and navigation services to enrollees and eligible patients into Managed Care, following organizational policies and guidelines. Ensure compliance with MCP and regulatory standards.
2. Assist eligible Medi-Cal, Medicare Advantage, and Covered CA patients with enrollment, transfers, and maintaining data records. Coordinate with MCP and Medicare Agents as needed.
3. Schedule appointments and assist walk-in patients with enrollment applications using Covered CA and BenefitsCal platforms.
4. Support patients in retaining active coverage, including Medi-Cal redetermination and Covered CA/Medicare renewals, utilizing EHR and other platforms for eligibility verification.
5. Address Managed Care coverage issues, providing information and orientation on options and processes.
6. Complete outreach attempts to ensure compliance with IHA guidelines, schedule IHA appointments within 120 days, and monitor follow-up and show rates.
7. Survey disenrolled members, assist with re-enrollment or exemptions, and document findings and patient assistance efforts.
8. Refer patients to DPSS as needed, support case escalation and resolution.
9. Document transfers and eligibility notes in EMR systems, follow-up on transfer courtesy visits, and manage patient flow.
10. Handle calls related to Managed Care issues professionally, log interactions, and communicate concerns appropriately.
11. Follow safety standards, participate in quality and safety programs, and attend relevant trainings.
12. Support the adoption and meaningful use of Electronic Health Records systems as required.
13. Perform other duties as assigned.

Requirements

• Associate's Degree and one year of Managed Care Enrollment experience, or 2+ years in healthcare. Experience in Managed Care Enrollment, Medical Front/Back Office, or Financial Screening preferred. Two years of customer service experience with strong communication skills.
• Complete Certified Application Assistant (CAA) Covered CA certification within the first month of hire.
• Bilingual in English and Spanish.
• Proficient in health information systems and Microsoft Office, with a typing speed of 35 WPM.
• Strong verbal and written communication skills, thorough, accurate, and detail-oriented.
• Reliable transportation to perform job functions at various locations.
• Ability to work effectively in a team-oriented environment.

Additional Information

• Seniority Level: Entry level
• Employment Type: Full-time
• Job Function: Health Care Provider
• Industries: Hospitals and Health Care