Outreach & Enrollment Advisor
Company: Inland Empire Health Plan
Location: Rancho Cucamonga
Posted on: March 15, 2020
Job Requisition ID: 4016
Under the direction of the Enrollment Assistance Manager, the
Outreach & Enrollment Advisor will research and assess Member's
potential eligibility for Medicare, Supplemental Security Income
(SSI), and/or Social Security Disability Insurance (SSDI) and
provide all assistance needed for the entire application
To accomplish this goal, the Outreach & Enrollment Advisor will
perform specialized case review by identifying all clinical and
administrative data needs for eligible Members and collaborating
with applicable departments (including Medical Directors) across
the organization to obtain and interpret the data needs for the
potential application. The Outreach & Enrollment Advisor will then
outreach to the Members (through all channels - phone, in-home,
digital channels, etc.), educating them on their potential program
eligibility. The Outreach & Enrollment Advisor will help the
Members complete an application, organize and coordinate all
logistics required for the entire application process, including
transportation, interpreter services, and presenting in-person with
the Members at all points during the application process.
The Outreach & Enrollment Advisor will interact and build
relationship with Providers, county Medi-Cal offices, and the
federal Social Security Administration offices. The Outreach &
Enrollment Advisor must enjoy working as a member of a team in a
cooperative effort and be able to exercise creative and independent
judgment to solve problems.
Major Functions (Duties and Responsibilities)
1. Perform a preliminary case review to identify Members who are
potentially eligible for Medicare, SSI and/or SSDI but have not
applied yet, by using the preliminary data provided by the
Marketing Research team.
- Conduct a specialized case review to identify all specific
clinical and administrative evidence and information required for a
potential Medicare, SSI and/or SSDI application.
- Partner with multiple departments, including Medical Directors,
Healthcare Informatics, Finance, and other applicable departments
to collect a full evidence set for the application.
- Review the full evidence set and thoroughly assess Members'
potential eligibility for Medicare, SSI and/or SSDI
- Screen all potential cases and then identify final cases for
- Outreach to eligible Members by phone and in-home appointment
(as requested) to inform and educate them about their new potential
eligibility for Medicare, SSI and/or SSDI benefits.
- Fully explain the Medicare, SSI and/or SSDI benefits to the
Members to obtain their agreement to participate in the application
- Work with the eligible Members to complete a full application
and explain all future steps.
- Organize all logistics required for the entire application
process, including interpreter services and transportation
- Provide hands-on assistance to the Members including making
appointments with Members' Doctor, the Social Security
Administration offices, or the county Medi-Cal offices.
- Conduct field activities, including accompanying with the
Members to all appointments (e.g., the Doctor and Social Security
Administration offices) if requested.
- Submit the application to the agency if requested by the
- Actively monitor the process after the application is submitted
and provide all assistance that the Members need.
- Conduct all follow-ups needed during the entire application
process until the application is processed and approved or
- Actively build a relationship with the county Medi-Cal offices,
Social Security Administration offices and other key agencies to
achieve the program's objectives.
- Follow all applicable regulatory guidelines and IEHP's
Leading: SelfExperience Qualifications
Three (3) or more years of experience in (1) directly reviewing and
approving or denying a Medicare, SSI and/or SSDI application, or
(2) working at the agencies that directly help consumers complete
an application for Medicare, SSI and/or SSDI benefits. Experience
in outreach and enrollment advisement for Medicare, SSI and/or SSDI
benefits. Ability to identify, collect, and interpret clinical and
administrative evidence requiring for Medicare, SSI and/or SSDI
benefits application. Ability to conduct effective outreach and
education to consumers to obtain their expressed agreement to apply
for their benefits.
High School diploma or GED required.
Bachelor's degree in Social Work from an accredited institution
A certificate of training or an equivalent evidence or proof about
a completion of training on Medicare, SSI and/or SSDI benefit
eligibility and/or application process.
Possession of a CA Health and Life License preferred.
Drivers License Required
Yes, must have a valid California Driver's license and valid
automobile insurance. Must qualify and maintain driving record to
drive company vehicles based on IEHP insurance standards of no more
than three (3) points.Knowledge Requirement
Must have mid to high level knowledge of eligibility criteria for
Medicare, SSI and/or SSDI benefits. Must fully understand the
entire Medicare, SSI and/or SSDI application preparation,
submission and review, approval or deny processes. Understanding of
and sensitivity to a multi-cultural environment and community.
Strong computer skills in Microsoft Word and Excel, and comfortable
with different technology CRM software. Excellent interpersonal,
communication, and coordination skills.
Must be able to exercise creative and independent judgment to solve
problems. Must have a high degree of understanding of the range of
services needed by the customers whom they interact with. Attention
to detail and quality assurance.
Commitment to Team Culture
The IEHP Team environment requires a Team Member to participate in
the IEHP Team Culture. A Team Member demonstrates support of the
Culture by developing professional and effective working
relationships that include elements of respect and cooperation with
Team Members, Members and associates outside of our
Word processing and data entry involving computer keyboard and
screens. Travel (drive) to many locations in Riverside and San
Bernardino counties in California.
Driving - FREQUENTLYKeyboarding: Traditional -
FREQUENTLYKeyboarding: 10-Key - FREQUENTLYKeyboarding: Touch-Screen
- FREQUENTLYKeyboarding: Other - FREQUENTLYUse of computer mouse -
FREQUENTLYHearing: One-on-One - FREQUENTLYHearing: In a group -
FREQUENTLYHearing: Over the Telephone/Cell Phone -
FREQUENTLYHearing: Conference Speakers/Video Calls/Radio Calls -
FREQUENTLYCommunicate: Information/ideas verbally -
FREQUENTLYCommunicate: Verbally engage with customer base -
FREQUENTLYCommunicate: Give instructions, advise, warn, instruct -
FREQUENTLYFar Visual Acuity - FREQUENTLYNear Visual Acuity -
FREQUENTLYPerform complex and varied tasks - FREQUENTLYDevelop and
maintain positive work relationships - CONSTANTLYAdaptability: rate
of change in work location - FREQUENTLYSimple Grasp -
FREQUENTLYStanding - FREQUENTLYWalking - FREQUENTLYSitting -
FREQUENTLYIndoors - FREQUENTLYOutdoors - FREQUENTLYLighting -
CONSTANTLYTraffic - FREQUENTLYAdaptability: rate of change in work
tasks - FREQUENTLYRegular contacts: co-workers, supervisor -
FREQUENTLYRegular contacts: recurring clients - FREQUENTLYOther
contacts: public exchange - FREQUENTLYDecision-making -
FREQUENTLYLead/Influence Others - FREQUENTLYWork review -
FREQUENTLYRapid Pace of work - FREQUENTLYControl of work place -
FREQUENTLYPace of work with faster/slower work periods -
FREQUENTLYProblem Solving - FREQUENTLYMemory - FREQUENTLYUnderstand
and follow direction - FREQUENTLYRegular and reliable attendance -
Starting Salary: $54,724.00 - $69,784.00
Pay rate will commensurate with experience
Inland Empire Health Plan (IEHP) is the largest not-for-profit
Medi-Cal and Medicare health plan in the Inland Empire. We are also
one of the largest employers in the region. With a provider network
of more than 6,000 and a team of more than 2,000 employees, IEHP
provides quality, accessible healthcare services to more than 1.2
million members. And our mission and core values help guide us in
the development of innovative programs and the creation of an award
winning workplace. As the healthcare landscape is transformed,
we're ready to make a difference today and in the years to come.
Join our Team and Make a Difference with us! IEHP offers a
Competitive salary and a benefit package with a value estimated at
35% of the annual salary, including medical, dental, vision, team
bonus, and retirement plan.
Nearest Major Market: Riverside
Nearest Secondary Market: Los Angeles
Keywords: Inland Empire Health Plan, Rancho Cucamonga , Outreach & Enrollment Advisor, Other , Rancho Cucamonga, California
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