Health Coverage Enrollment Aide

JOB ANNOUNCEMENT Position Title: Health Coverage Enrollment Aide Department: Fiscal Supervised By: Revenue Cycle Manager Location: Alpine / Campo Status: Non-exempt Posted: August 29, 2024 Closing Date: September 12, 2024 Compensation: $21.00 - $29.11/hr - DOE Grant Funded: N/A Clinic Hours: Monday-Friday, 8:00AM-4:30PM Willingness to work flexible hours including some evenings and weekends may be required. GENERAL STATEMENT OF RESPONSIBILITIES: The Health Coverage Enrollment Aide initiates and completes the application process for Medi-Cal, Medicare, Covered California and/or other health programs for patients/clients. Executes, collects, and submits all the necessary documentation to apply for health insurance benefits and/or programs. This position will track patients/clients approved insurance benefits related to redetermination, renewals, and appeal process for denials. Provide education to the community of the importance of obtaining health insurance benefits and/or programs. Work closely with all departments to recognize and inform uninsured patients/clients of the benefits of obtaining health insurance. SPECIFIC DUTIES AND RESPONSIBILITIES: Offers coverage services to uninsured patients and their families to inform them of the availability and eligibility requirements of various health insurance coverage (Medi-cal, Medicare, HMO/PPO) and/or programs (CalFresh, IHSS, HICAP for pre-Medicare beneficiaries). Coverage services includes becoming the “Appointment of Representative” and building then maintaining rapport with the patient/client. Submit applications for patients and their families for qualified health insurance benefits to assure accuracy of required documentation and timely follow-up on those applications. Meet with patients outside of clinic (with supervisor approval) to assure completion of applications. Prepare Weekly Reports of enrollment progress and outreach efforts. Monitor patients and families for continuous coverage in various programs. Maintain current knowledge base regarding insurance terminology such as benefits, co-pays, health plan network – and disseminate information regarding any changes. Work with county eligibility workers and county offices to create a positive working relationship. Create/maintain contact list with numbers (phone, fax) Demonstrate ability to set priorities to accomplish tasks and work effectively: Maintain client files for all applications/correspondences Communicate in the file steps taken to complete application Schedule follow-up appointments/phone calls with patients and case workers Provide PRC/Billing department proof of approved health insurance coverage and/or programs Ensures confidentiality of patient/client, employee, and Tribal records Maintains a clean and organized work area Collaborate with SIHC events to conduct outreach events for Covered CA related topics for the community. Maintain knowledge of county, state, federal, tribal policies on eligibility for services as well as financial resources for Indian people in the service area. Assist, explain, educate, and advocate for individuals concerning benefit changes, plan changes, disenrollment, re-enrollment, and appeals. Must attend all mandatory department trainings, CEC required trainings, and other trainings deemed necessary. Displays a responsive and professional manner in promptly responding to all requests, complaints, and problems. Ability to work flexible schedule may be required based on need. Other duties as assigned. QUALIFICATIONS: Education/Experience: High school graduate or GED equivalency required. Experience assisting patients with insurance or government funded programs in a medical or human services setting, performing eligibility assistance, case management, referrals or related function required. Enrollment counselor with one (1) to two (2) years of professional, supervised experience will be considered. Certified Enrollment Certificate is required, if not certified at the time of hire; employee must become certified within 90 days of hire and must maintain certification for the duration of employment. Employment is contingent of this requirement. Knowledge of computer applications to include Microsoft Office. Travel may be necessary. License/Certifications: A valid California driver’s license required with application submission and must be maintained throughout employment. Current certifications and/or licenses appropriate to the positions required education and profession. Certifications and/or licenses appropriate to the positions required education and profession must also be valid and maintained. Character: Applicants must have a reputation for honesty and trustworthiness. Must be responsible and able to exercise good judgment, accept administrative supervision, pay attention to detail, follow instructions, including the ability to interact effectively and communicate with people in a professional and courteous manner. Must be highly confidential and work as a team with other staff. Applicant should be sensitive to client’s needs. Skills: Strong team building, interpersonal, and organizational skills. Ability to establish and maintain effective peer relationships with coworkers within the Department, clinic-wide, and the public. Must be able to express ideas clearly, concisely, address audiences effectively, and exercise balanced judgment in evaluating situations and making decisions. Willing to be part of a team and cooperate in accomplishing department goals and objectives. Ability to prioritize, meet deadlines, take initiative, be proactive, and function in a rapidly changing environment. Ability to work with people of all social and ethnic backgrounds and to resolve conflicts, negotiates situations, and facilitate consensus. Physical and Personal Requirements: Normal clinic/office environment. Sit or stand for long periods of time. Reach, bend, climb, stoop, lift up to 25 lbs. repetitive hand movement; use and view PC. Reliable transportation and car insurance as required by the state. Travel as needed. Compliance: Each employee plays a key role in creating a compliance culture at SIHC. Employees are expected to learn and comply with all SIHC policies and procedures. One must have the ability to understand the implications and complexities of all compliance policies. Participation in all compliance training is mandatory, and generally have a heightened awareness of policies and regulations that are specific to one’s department and position. All SIHC employees are expected to report violations or suspected violations of compliance policies or regulations. Other: Applicants must successfully pass a pre-screening tuberculin skin test or x-ray and a blood/urine drug screening test. Health must be adequate to perform all duties of the position. Applicant must complete SIHC Application and Authorization Form, both must be submitted to Human Resources prior to the close date indicated. INDIAN PREFERENCE: INDIAN PREFERENCE: In the filling of any SIHC job vacancy, preference may be given to qualified Native American Indians, pursuant to the Indian Preference Hiring Act, 25 USC 472, unless other laws require the filling of a vacancy without regard to Indian preference (e.g. Public Law (P.L.) 94-437, “Indian Health Care Improvement Act (IHCIA). To receive Indian preference for any SIHC position, the applicant must be enrolled, or be eligible for enrollment, as an American Indian with their Tribe, or must be certified as an American Indian from the designated Tribal Representative. Applicants claiming Indian preference must attach verification of their claim to the SIHC application, including Certification of form BIA-4432, which is available from the SIHC Human Resources Department. If verification is not or cannot be verified, the applicant will not receive Indian preference for purposes of the interview.