Patient Benefits Enrollment Specialist Level 1

Upham's Community Care; Boston (MA); On-site; USD 25,000 - 34,000; Full time

Job summary

Upham's Community Care is hiring a Patient Benefits Enrollment Specialist to help uninsured or under-insured patients enroll in government-sponsored coverage. The role requires CAC and Navigator certifications within one month and bilingual communication skills.

The specialist will educate patients, verify demographics, assist with MassHealth applications, and manage enrollment appointments while maintaining HIPAA standards and collaborating with multiple departments.

Qualifications

• Two years of direct customer service experience.
• CAC certification required; Navigator certification required.
• Bilingual English/Spanish and/or Portuguese Creole preferred.
• Excellent verbal and written communication skills and strong documentation.
• Ability to work in a fast-paced, diverse environment and multi-task across systems.
• Knowledge of HIPAA and patient confidentiality practices.

Responsibilities

• Maintain CAC and Navigator certifications.
• Assist uninsured/under-insured patients with applying for government-sponsored coverage.
• Educate patients about enrollment and MyChart portal access.
• Schedule enrollment appointments and perform outreach for no-shows.
• Verify patient demographics and insurance information.
• Assist with MassHealth open enrollment and redetermination processes.
• Document data entry and ensure audit readiness in collaboration with leadership.
• Provide guidance on Sliding Fee Discount and related policies.

Skills

Bilingual English/Spanish

Customer service experience

Communication skills

Organizational skills

EPIC

Virtual Gateway

Education

High School Diploma or GED

Tools

EPIC

Virtual Gateway

Job description

Position Title: Patient Benefits Enrollment Specialist Level IDepartment: Patient ServicesSupervisor: Patient Services ManagerStatus / Hours per week: Full Time / Non-Exempt (40 hours/week)Pay Range: The expected base pay for the position is $18-$25 per hour and may be increased based on other factors, such as language, certifications, etc.Primary Function:The Patient Benefits Enrollment Specialist Level I assists uninsured and under-insured patients in applying for the most comprehensive government-sponsored health insurance coverage they qualify for based on family size, family income, and immigration status.This position also assists patients with selecting and enrolling in an insurance plan, selecting a primary care provider, and setting up premium payments, as applicable.This position is required to obtain the Massachusetts CAC (Certified Application Counselor) and Certified Navigator Training Certification (for Navigator Grant) within one month of employment and maintain this certification throughout their time in this position.Duties & Responsibilities:• Maintains both Certified Application Counselor (CAC) and Navigator Training Certifications (for Navigator Grant).• Ensures Enrollment Staff are following Sliding Scale Discount Program Policy & Procedures.• Supports multiple clinical departments, such as Primary Care, Urgent Care, Women’s Health, Behavioral Health, Specialties, including Dental and Eye with their uninsured and under-insured patients seeking services.• Follows all health center policies and procedures on patient confidentiality/HIPAA and all health center-wide guidelines.• Verifies patient demographic and insurance information.• Actively listens to Level 2's & 3's and pays attention to feedback that is given.• Educates patients on enrollment into the patient electronic record portal system, MyChart.• Schedules and signs in patients for their Enrollment Appointments.• Outreaches to patients that do not keep their Enrollment appointments.• Follows end of day (EOD) procedures for patients that do not show for (DNK) their Enrollment Appointment.• Screens patients for basic eligibility into Massachusetts government-sponsored health coverage programs, such as MassHealth, HSN, Health Connector, etc. by checking residency, income and family size.• Assists patients in completing on-line applications and manually completes the extensive 65 and older MassHealth application.• Assists patients with the MassHealth re-determination process to minimize any disruptions in coverage through proactive outreach from C3 lists and other sources as well as through patient walk-ins.• Assists patients with other eligibility programs, such as Medicare Part D Prescription Drug Coverage through research using Medicare’s website; and assists patients with the Medicare and MassHealth Open Enrollment periods.• Answers patients' inquiries, translates, and completes data entry plus other clerical tasks.• Educates patients about UCC Enrollment brochure and other services at UCC locations.• Attends Massachusetts Health Care Training Forum-Webinars• Collects and obtains signatures on all patient compliance related documents.• Outreaches individuals from the C3 ACO MassHealth Redetermination files to assist them in maintaining their eligibility with MassHealth to avoid a gap in coverage.• Updates insurances in the UCC patient’s EMR.• Manages returned Enrollment mail by outreaching the patient to obtain an updated address and phone number; updates the EMR and MassHealth contact information.• Assists patients with billing issues and notices received from MassHealth, Connector Care, and other insurance plans.• Troubleshoots for patients with issues, such as lost or stolen insurance cards, requesting updates to information in the system, etc.• Assists patients in completing the Sliding Fee Discount Application as requested or applicable, completes accurate data entry of the sliding scale into OCHIN, and assures UCC is audit-ready in collaboration with leadership.• Educates patients about UCC’s Senior Care Options (SCO), PACE (Program or All-Inclusive Care), and other programs (Advocates, HIV, etc.).• Maintains written tracking of all activities relating to outreach, enrollment, re-enrollment, member assistance and other relevant information.• Answers patient and internal staff calls.• Must be willing to work evenings and/or Saturdays.• Handles other duties as needed/assigned.Minimum Basic Knowledge:• High School Diploma or its equivalent (GED)• Bilingual language skills in English/Spanish and/or Portuguese Creole highly preferredExperience & Qualifications:• Updated Massachusetts CAC (Certified Application Counselor) certification required.• Updated Navigator Certification required.• Minimum of two (2) years of experience working in a direct customer service role.• Required to understand and explain all the enrollment requirements for all government-sponsored programs.• Ability to work with persons with disabilities and seniors.• Demonstrated oral and written communications skills.• Strong documentation and excellent organizational skills.• Experience working in a fast-paced, diverse environment.• Experience and demonstrated proficiency in computer systems and PC-based software.• Excellent customer service skills.• Ability to work effectively within a team.• Ability to multi-task on two computer systems (Virtual Gateway and EPIC) at the same time.• Ability to take initiative and exercise excellent judgment, make excellent decisions and advanced problem-solving capabilities.Independent Action:As described above at “Duties & Responsibilities”.Supervisory Responsibility:None, but is able to provide input to workflow improvements.Define Access Level to PHI: Level 2: Authorized to access patient demographic data with only minimal reference to treatment or diagnostic information as needed to function. Staff in this category level should confine the use of PHI to the minimum necessary required and should not access or read parts of the medical record not needed to perform assigned duties.