Medicaid Enrollment Representative

Health Partners of Western Ohio

Lima (OH)

On-site

USD 29,000 - 37,000

Full time

3 days ago

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Benefits offered by this job

Health Insurance

Paid Time Off

403b Retirement with match

Paid Holidays

Employee Assistance Program

Referral Bonus

Emerging Leaders Program

Job summary

Health Partners of Western Ohio in Lima, OH is seeking a dedicated Enrollment Counselor to educate and assist patients with enrollment into affordable health insurance options including Health Insurance Exchange, Medicaid, CHIP, and Medicare. You will screen uninsured individuals, help them obtain public benefits, and perform monthly CR audits to ensure compliance.

The role emphasizes in-reach and outreach activities, CAC training, and accurate, confidential processing within HIPAA guidelines,

Qualifications

High School Diploma or equivalent; Associate degree preferred.
Must complete CAC training (in-house).
Knowledge of Medicaid enrollment process and public benefits programs.

Responsibilities

Conduct outreach to uninsured and service-area residents.
Explain eligibility rules for Medicaid, CHIP, and Marketplace.
Assist with a single application to determine eligibility.
Maintain patient confidentiality and HIPAA compliance.
Document interactions in the EHR and track follow-ups.

Skills

Communication skills

Medicaid enrollment knowledge

Public benefits programs knowledge

Independent work

Driver's license & travel

Education

High School Diploma

Associate in Health or Human Services (preferred)

Job description

Location:

Lima, OH

Job Id

3366

# of Openings

Admin Building

About Us

Health Partners of Western Ohio is an independent, non-profit and community-directed organization. We serve low-income areas and places without access to care. We’re led by a volunteer Board of Directors. Most of our board members are also patients. Our Mission is to eliminate gaps in health outcomes for all members of our community by providing access to quality, affordable, preventive and primary health care.

SUMMARY

Responsible for providing education and assistance to health center patients and service area residents with the enrollment into affordable health insurance options including Health Insurance Exchange, Medicaid, Children’s Health Insurance Program (CHIP), and Medicare. Screens and assists uninsured and underinsured patients in obtaining public benefits charity or other financial sponsorship from outside agencies and charitable programs when financial need is indicated. Completes CR audits monthly.

ESSENTIAL FUNCTIONS AND BASIC DUTIES

Conducts “in reach” activities with currently uninsured health center patients and “outreach” to non-health center persons within the health center’s service area
Complies with and successfully completes all required Certified Application Counselor (CAC) training.
Demonstrates and maintains expertise in eligibility and enrollment rules and procedures; the Health Insurance Exchange options in the Marketplace and insurance affordability programs, including Medicaid and Medicare.
Assists patients and/or consumers in obtaining access to a single application process that will enable them to determine if they, or a family member, are eligible for enrollment under Medicaid or CHIP, or if they are eligible for financial assistance (waiver) for qualified health plan offered through the Marketplace.
Provides information and assistance in a fair, accurate and impartial manner that is culturally and linguistically appropriate to diverse communities and accessible to individuals with disabilities.
Demonstrates an understanding of the needs of the undeserved and vulnerable populations and abides by privacy and security standards.
Respects and maintains patient confidentiality according to health center policy and HIPAA regulations.
Assists with training staff on sliding fee scale.
Completes audits of CR’s monthly
Provides referrals to any applicable office of health insurance consumer assistance or ombudsman established under Section 2793 of the Public Health Services Act to address consumer grievances, complaints, or questions about their health plan, coverage or determination.
Develops and maintains a tracking and follow-up system for Medicaid and other social services applications to ensure that all aspects of the process, from application through post-enrollment, have been completed and that the patient is able to receive appropriate services.
Attends and participates in staff meetings.
Documents in designated computer system all interaction with patients to ensure proper follow up once patient has been released.
Promotes and maintains positive behaviors and professional atmosphere.
Maintains patient financial records in EHR.
Performs other related duties as they are assigned.

QUALIFICATIONS

EDUCATION/CERTIFICATION

High School Diploma or equivalent is required, with Associates in Health or Human Services or related field preferred.

REQUIRED KNOWLEDGE

Successful completion of in-house training.

SKILLS/ABILITIES

Communicating effectively in both written and verbal form.
Understanding of the Medicaid enrollment process and low-income services.
Knowledge of state and federally funded public benefits programs preferred.
Knowledge and demonstration of eligibility and enrollment rules; knowledge of qualified health plan options as well as Medicare, Medicaid, Commercial and CHIP.
Must be able to work independently.
Maintain a valid driver’s license; ability to travel between health center sites and throughout the health center’s service area.

WHAT WE OFFER

Starting pay $21.60 and goes up based on experience in Federally Qualified Health Center billing
Paid Time Off (PTO) – Accrued per pay
Insurance (Medical, Dental, Vision, Life and Disability)
Paid Holidays – 7 paid holidays
403b Retirement with up to 8% match (starts at 3% and increases with time of service at HPWO)
Annual Reviews and Increases
Employee Assistance Program
Referral Bonus – Earn more by expanding our team
Eligible to apply for the Emerging Leaders Program after 1 year of service