Managed Care Enrollment Specialist

YVFWC has a compulsory vaccination policy including the Covid-19 primary series, the organization does not mandate the Covid-19 booster although it is offered through our employee health department. Medical and religious exemptions to the primary series will be considered and for those approved, the employee should anticipate following appropriate guidance around masking and other protective equipment offered. 

Responsible for enrolling and retaining Managed Care Medicaid patients and establishing them with providers within the network. Responds to inquiries and complaints from applicants, members, clinic staff, providers, and outside specialists.

Essential Functions/Responsibilities/Duties

  • Works directly with patients to enroll and maintain healthcare coverage.
  • Completes Affordable Care Act (ACA) applications, Medicaid renewals and other required updates.
  • Identifies eligibility problems and performs appropriate research, documentation, and follow through to find solutions.
  • Performs outreach to get new patients. Coordinates their appointments to establish care with Providers in the clinics. 
  • Provides education regarding ACA to current and prospective members.
  • Processes referrals and responds to customer inquiries.
  • Explains benefits, procedures, and protocols to external and internal customers.
  • Submits required documentation to Managed Care plans for plan approved referrals.
  • Manages work to meet or exceed goals for response time and quality for the call center.

Qualifications

  • Education: High School Diploma or General Education Diploma (GED). Associate of Art Degree in business or a similar field perferred. 
  • Experience: One year of experience interacting with the public in a business environment. One year’s experience working in a healthcare environment with experience in health care information systems preferred. 
  •  Professional Licenses/Certificates/Registration: Certified ACA navigator or completion of ACA training and certification within 90 days of employment. 
  • Knowledge/Skills/Abilities Required: Bilingual (English/Spanish) preferred. This position is not eligible for bilingual differential pay. Knowledge of health care systems highly desirable. Ability to write concise, organized, and clear communications. Effective verbal, written and listening communication skills. Ability to develop effective working relationships to gain trust and establish credibility. Strong organizational skills and strong attention to detail and accuracy. Knowledgeable in the use of standard office equipment. Ability to manage stressful situations and work in a fast-paced and rapidly changing environment.

About YVFWC

We serve more than 181,000 patients across 25 medical clinics, 14 dental clinics, 10 pharmacies, and 64 program sites in two states. We are Level 3 Certified as a Patient-Centered Medical Home (PCMH). With integrated services including medical, dental, pharmacy, orthodontia, primary care nutritional counseling, autism screening, and primary care behavioral health, YVFWC’s patient-centered model of care offers patients the full spectrum of care and shelter assistance, energy assistance, weatherization, HIV and AIDS counseling and testing, home visits, and four mobile medical/dental clinics.

Working at YVFWC

Working in our organization means being the passionate champion for those who have no voice. It means having the opportunity to work with underserved populations and with peers committed to the same work.

At Farm Workers Clinic

  • We will consistently trust one another to work for the common good.
  • We will foster integrity by demonstrating ethical behavior and insisting on doing what we say we will do.
  • We will demonstrate transparency by being candid and truthful no matter the risk.
  • We will create partnerships to strengthen ourselves and our community.
  • We will fight for just treatment for all individuals.
  • We will let joy in.
  • We have the courage to be an agent of change and refuse anything short of excellence.

Our mission celebrates diversity. We are committed to equal opportunity employment.

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