Enrollment-Outreach Specialist

Job Description

Job Description

ENROLLMENT - OUTREACH SPECIALIST

EXPOSURE CATEGORY II

BASIC PURPOSE & SCOPE:

Under the direction of the Associate Program Director – Center Manager, will assist with the intake and enrollment process for potential Total Senior Care participants, Total Senior Care Inc., an established Program of the All-Inclusive Care for the Elderly (PACE) and managed long term care plan in New York State, as well as Daybreak, a certified social model adult day program. The specialist will work independently to take inquiries and referrals into the program, gather information, provide an explanation of PACE services and set appointments for assessments, visits and tours. The specialist will interact with family caregivers and potential participants and provide tours through the PACE center as needed and gathers critical information for the new participant enrollment process including documentation for Medicaid applications as well as other necessary intake and enrollment paperwork.

RESPONSIBILITIES:

Under supervision and in accordance with all applicable federal, state and local laws/regulations and Total Senior Care policies, procedures and guidelines, this position:

1. Serves as the initial encounter for program information and follow up to telephone or walk-in inquiries and sources of referral.
2. Gathers all necessary information and answer questions while educating individuals about available services.
3. Assists in collecting all patient demographic information and required paperwork throughout the enrollment process within designated timeframes.
4. Conducts eligibility screening, phone intake, education and enrollment assistance activities to initially determine participant needs and eligibility for enrollment.
5. Develops and maintains relationships with potential participants who call and/or email to inquire about PACE, working to secure a face-to-face meeting with an enrollment-outreach supervisor or coordinator.
6. Conducts tours of the facility for potential participants and family caregivers at the PACE center and explains the services provided while exhibiting professionalism and exceptional customer service.
7. Serves as a subject matter expert for Medicare/Medicaid; answers questions and explains processes in a clear and understandable way.
8. Works in conjunction with other enrollment – outreach staff to provide clients with information about Medicaid benefits, eligibility requirements and other community support services.
9. Assists potential enrollees with the Medicaid application process and follows the process to completion; verifies eligibility factors, provides and gathers information and ensures all necessary information is provided accurately.
10. Stays current on changes in Medicaid policies and procedures through ongoing training and development.
11. Complies with all marketing guidelines related to managed care as set forth by federal, state and agency guidelines and prohibited marketing practices.
12. Assists prospective participants and caregivers with applications and documentation needed to facilitate financial eligibility.
13. Identifies and tracks issues, trends, and efficiencies in the PACE enrollment process; presents solutions to barriers for enrollment.
14. Maintains accurate and up-to-date records related to participant referral and enrollment in accordance with the program policy and applicable regulations.
15. Has the ability to interact professionally and respectfully with geriatric individuals including those with cognitive decline and/or physical frailties..
16. Responsible for understanding and documenting medical and social indications of potential PACE participant to determine initial needs.
17. Works as part of a team to educate potential participants and their caregivers on the benefits of the PACE program
18. Prepares assigned reports.
19. Treats all people with dignity and respect following privacy and participant rights policies and procedures.
20. Adheres to and reflects organizational values in daily work.
21. Serves on agency committees as may be assigned.
22. Maintains an obligation to report wrongdoing/violation of agency policies, applicable federal, state, and local laws, and rules and regulations pertaining to agency operations, to immediate supervisor or identified compliance officer.
23. Completes all mandatory inservice education programs and completes any other additional inservice hours that are minimally required for the position.

The above examples of work may not be a complete statement of all assignments that may be inherent to the position. Other duties may be assigned as deemed necessary and appropriate by the Program Director and/or President/CEO.

MINIMUM REQUIREMENTS:

1. High school diploma required or Associate’s degree preferred from an accredited college and/or institution in health care

administration, health-related or human services field or business administration/

management, or licensed practical nursing.

3 years of experience in an administrative or office role; experience in a medical setting preferred.

1. One year career and/or volunteer experience with the care of the frail elderly.
2. Working knowledge of principles and practices of healthcare, healthcare systems, managed care, Medicare and Medicaid benefits and regulations preferred.
3. Experience with data entry and database management using Electronic Medical Record (EMR) systems or equivalent systems a plus.
4. Effective oral and written communications required.
5. Able to meet the transportation requirements and needs applicable to the position’s

duties, functions and responsibilities.