Enrollment Specialist

Career Center; Somerset West; On-site; ZAR 180,000 - 240,000; Full time

Job summary

Mosaic seeks an Enrollment Specialist to serve as the primary contact for insurance applications and eligibility, including state and federal programs. The role involves outreach, enrollment reporting, and coordinating with clinics to verify and register patient information in the EMR.

The position requires educating patients on Medicaid eligibility, navigating enrollment processes, and maintaining accurate EHR records. Strong communication and bilingual abilities are a plus.

Qualifications

• Bi-lingual in Spanish/English preferred.

Responsibilities

• Aid and process state and/or federal applications for insurance coverage for patients and community members.
• Troubleshoot application questions or concerns from patients and community members.
• Serve as a liaison between state/federal systems and patient, providing timely follow-up and processing of applications and insurance eligibility status.
• Monitor enrollment reports to identify enrollment assistance needs.
• Active patient outreach to capture patient eligibility status at patient visit.
• Community outreach to educate and assist community members with enrollment needs.
• Advise patients of their Enrollment status with Medicaid/Medicare and aid as needed.
• Advise patients of financial and/or insurance documentation required for appointments as well as educate patients on different payment options offered.
• Schedule patients in Enrollment appointments as needed.
• Provide system or clinic support for New Patient and Enrollment scheduling, rescheduling, and cancellations.
• Confirm patient demographics, registration, and insurance information and update EHR as needed.
• Promote and educate, MyChart use.
• Create new patient records in EHR.
• Patient activation and education on use and benefits of MyChart.
• Complete the patient registration process and document in the EHR.
• Educate patients on FPL, Medicaid, and Marketplace requirements as well as assisting with over the phone support when possible.
• Auditor of patient charts to ensure accurate financial registration.
• Updates patients charts to ensure accurate financial registration including coverage’s, guarantors, demographics, annual incomes, and any other registration field that needs correcting
• Reaches out to patients to get updated corrected information for accurate financial registration.

Tools

EMR/EHR systems

Job description

Description

The Enrollment Specialist is the primary point of contact for Mosaic patients with insurance applications and eligibility requirements with state and/or federal insurance programs, including Oregon Health Plan. This includes contacting patients for re-enrollment and assisting the Billing Department with insurance verifications. The Enrollment Specialists will conduct Outreach activities with community partners and other organizations to provide information and enrollment assistance. This position will develop and maintain statistical enrollment reports and manage reports provided by the organization for enrollment and re-enrollment. This position will travel throughout the region to support enrollment assistance. Additionally, this role will be handling pre-registration and registration pre verification for all patients at Mosaic, new or established. Entering, auditing, educating, and advocating for accurate registration in the patient’s electronic medical record (EHR). This role identifies patients who have termed from Medicaid/Medicare. When termed, reaches out to patients to inquire as to why they termed and assists patients in navigating the Enrollment process. Provides education on Medicaid eligibility and sliding scale eligibility. Bi-lingual in Spanish/English strongly preferred.

• Aid and process state and/or federal applications for insurance coverage for patients and community members.
• Troubleshoot application questions or concerns from patients and community members.
• Serves as a liaison between state/federal systems and patient, providing timely follow-up and processing of applications and insurance eligibility status.
• Timely documentation of all assistance including insurance eligibility status in the electronic medical record (EMR) per procedure.
• Monitor enrollment reports to identify enrollment assistance needs.
• Active patient outreach to capture patient eligibility status at patient visit.
• Community outreach to educate and assist community members with enrollment needs.

Customer and Access Services

• Advise patients of their Enrollment status with Medicaid/Medicare and aid as needed
• Advise patients of financial and/or insurance documentation required for appointments as well as educate patients on different payment options offered

Scheduling

• Schedule patients in Enrollment appointments as needed
• Provide system or clinic support for New Patient and Enrollment scheduling, rescheduling, and cancellations
• Confirm patient demographics, registration, and insurance information and update EHR as needed
• Promote and educate, MyChart use
• Create new patient records in EHR
• Patient activation and education on use and benefits of MyChart
• Complete the patient registration process and document in the EHR
• Educate patients on FPL, Medicaid, and Marketplace requirements as well as assisting with over the phone support when possible

Registration Pre-Verification

• Auditor of patient charts to ensure accurate financial registration
• Updates patients charts to ensure accurate financial registration including coverage’s, guarantors, demographics, annual incomes, and any other registration field that needs correcting
• Reaches out to patients to get updated corrected information for accurate financial registration