- Full Time/Contract
- Provider Relations
- Rancho Cucamonga, CA
Healthcare Enrollment Advisor
Under the direction of the Enrollment Advisor (EA) Call Center Manager and the EA Supervisor, the EA staff person is primarily responsible for receiving inbound calls related to the identification, information sharing and qualification of potential Company members. Additional responsibilities will include call follow-up to potential members who requested enrollment assistance and information. The EA will document all contacts and case activities.
- Pass and maintain any necessary license or certification required for any Health Program the Company is participating in.
- Consistently meet or exceed daily, weekly and monthly quotas for providing screening and/or application assistance, for inbound and outbound calls. Failure to meet established quotas on a consistent basis will be grounds for immediate performance review.
- Will work a normal (8 a.m. – 5 p.m. or 9 a.m. – 6 p.m.) workday, but work schedules and hours may vary depending upon Marketing and Advertising meetings, promotions and trainings. The Enrollment Advisor will be provided at least one week's notice when a managerial change of a work schedule and/or hours is required.
- Provide telephone screening and/or application assistance for Medi-Cal,, Healthy Kids and other state health programs. As appropriate, the EA will fill out any applicable application form, while the customer is on the phone, then provide instruction for all related follow-up procedures and processes.
- Provide in person assistance and/or application completion to any potential member who walks in and requests enrollment assistance, application completion and/or information.
- Qualify candidates by calculating their household income and by using other approved qualification methods and worksheets.
- Become an expert regarding State Health Programs and the application and enrollment process, to advise candidates of the documentation required to complete the application and answer questions and issues about the enrollment process.
- Completion of all assigned reports or documentation to facilitate the successful enrollment into a designated program to include: qualification worksheets, applications, appropriate letters, instructions to potential candidates and daily/weekly activity reports.
- Must be courteous, friendly and customer oriented.
- Must have the ability to multi-task in a high pressure environment while maintaining a high level of performance.
- Must be comfortable working with a language line, translators and other special devices and programs when communicating with candidates that speak other languages and/or have a disability.
- Must be an independent self-starter who effectively communicates parameters of a Health Program within the guidelines of a defined script.
- At times will be asked to assist in the development and training of new Enrollment Advisors.
- Will be responsible for incoming and outgoing mail and other administrative unit duties.
- Documents all calls in detail so a recorded history is created for future interaction with each family.
- Ability to present cases and work with a Supervisor in resolving potential member or member issues.
- Ability to answer questions from potential members, and act as a subject matter expert in regards to state programs (Medi-Cal/Healthy Families).
- Any other duties as required to ensure Health Plan operations are successful.
- Ensure the privacy and security of PHI (Protected Health Information) as outlined in Company's policies and procedures relating to HIPAA compliance.