Lead Benefits Enrollment Coordinator

hace 1 mes

Puerto Diablo, Puerto Rico Uphams Corner Health Center A tiempo completo

Job Details Job Location
415 Columbia Rd - Dorchester, MA

Position Type
Full Time 30+ hours

Education Level
Not Specified

Travel Percentage
None

Job Shift
Day

Job Category
Health Care

Description Position Title: Lead Benefits Enrollment Coordinator
Department: Patient Services
Supervisor: Patient Services Manager
Employment Status/Hours per week: Non-Exempt / 40 hours

Primary Function:
Under the direction of the Patient Services leadership, the individual in this role leads the Enrollment department and staff, and also performs duties of the Lead Benefits Enrollment Coordinator role by assisting uninsured and under-insured patients with enrollment in appropriate government-sponsored health insurance coverage programs, based on family size, income and categorical eligibility as well as residency requirements following the Massachusetts CAC (Certified Application Counselor) certification requirements.

Duties & Responsibilities:
•Assure optimal patient flow in the Enrollment Department so that patients with scheduled appointments are seen as a priority over walk-ins; continually assess the balance of appointment access versus walk-ins; makes recommendations to the schedule template.
•Provide quality monitoring of the Virtual Gateway applications processed by the Enrollment staff; provide staff with feedback on quality of work and share opportunities for improvement.
•Provide training, coaching, and resource support for all Enrollment staff including the customer service delivery and accuracy and comprehensiveness of the staff following the step-by-step protocols to enter data in the Virtual Gateway applications, schedule accurate Enrollment appointments, and process accurate and complete Sliding Fee Discount (SFD) Applications.
o This includes access and training of EPIC/OCHIN functionality in terms of patient registration, insurance verification, appointment scheduling, template management and internal referrals; monitor and manage the 'Benefits' work queue.

•Assure follow up and tracking of the monthly Virtual Gateway applications and enrollments processed by the Enrollment Department and complete a quarterly and monthly grants reports.
•Assure the Enrollment Department's processing of the C3 re-determination reports, making every attempt to retain C3 member eligibility in MassHealth whenever possible.
•Handle quality review staff entry of the sliding scale discount applications and accurate data entry of the sliding scale into EPIC/OCHIN; assure UCC is audit-ready in collaboration with the Manager.
•Provide consultation with other UCC staff and providers on patient eligibility programs; share knowledge with others.
•Assist patient with other eligibility programs, such as Medicare Advantage Plans, Medicare Part D Prescription Drug Coverage and/or Prescription Advantage through research and make recommendation for expanded scope of assistance provided;
o Obtain SHINE certification within one year of hire in order to assist patients age 65 and older and the disabled population by assisting with Medicare eligibility and products (examples: Medex, Medicare Advantage Plans, or stand-alone Prescription Drug Plans); work closely with SHINE.
•Provide input to staff performance appraisals and corrective action or performance improvement plans as needed.
•Assure that Enrollment staff are productively working during their assigned shifts and attentive to patient needs.
•Assure Enrollment Department signage and brochures are kept up to date and reflect any changes in operations.
•Attend MassHealth Training Forums and other relevant meetings and trainings to stay updated on all changes to the government-sponsored health coverage programs.
•Enter and maintain Sliding Fee Discount Program eligibility information for eligible patients in EPIC/OCHIN we well as entering and maintaining MassHealth Pending for patients/family members through a OCHIN Work queue.
•Manage the distribution and completion of all incoming department mail requests.
•Handle all customer calls with the highest level of customer service in a courteous and professional manner.
•Document accurately and timely online call notes in a manner that others can understand the nature of the call and actions taken for resolution.
•Must be willing to work evenings and weekends; attend occasional community outreach events as scheduled.
•Handle other duties as needed/assigned.

Qualifications Minimum Basic Knowledge:

•Familiarity and knowledge of EPIC/OCHIN for appointment scheduling and entering coverages as well as Sliding Scale Discount information.
•Must possess updated Massachusetts CAC (Certified Application Counselor) certification.
•Knowledge of Benefits and MassHealth eligibility, categorical and residency requirements as well as other government-sponsored health coverage programs.
•Bilingual or trilingual language skills (English along with Spanish, Portuguese, and/or Creole).
•Must receive Navigator Application certification (requires passing a test and receiving SHINE certification within a year of starting the position).

Experience & Qualifications:

•Minimum of two (2) years' experience working in a direct customer service role.
•Proven ability to make recommendations to workflow improvements and protocols that benefit the patients and health center operations.
•Ability to research and interpret benefits plan rules.
•Ability to maintain knowledge of current benefit related governmental regulations and administration.
•Demonstrated oral and written communication, and documentation skills.
•Effective planning and priority setting skills; ability to manage several complex projects while working under pressure to meet deadlines.
•Excellent skills in customer service and attention to detail
•Ability to maintain confidentially regarding Protected Health Information (PHI) and maintain HIPAA compliance for the organization.
•Ability to manage escalated patient and visitor issues received from staff, and use sound judgement to create solutions
•Ability to analyze and research problems in order to develop a course of action.
•Ability to work in a fast-paced, diverse environment, including work with seniors and those with disabilities.
•Experience and demonstrated proficiency in computer systems and PC-based software, such as Virtual Gateway, Epic/OCHIN.
•Strong organizational, presentation, and planning skills.
•Ability to work effectively within a team.

Independent Action:
Ability to take initiative and show accountability as required by job duties listed.

Supervisory Responsibility:
None, but serves as team lead to other Enrollment staff to ensure smooth operation of enrollment function; and provides input to workflow improvements and staff performance.

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.

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