Outreach & Enrollment Advisor

Company: Inland Empire Health Plan
Location: Rancho Cucamonga
Posted on: March 15, 2020

Job Description:

Job Requisition ID: 4016
Position Summary/Position
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 process.

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.

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• 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 benefits.
  
• Screen all potential cases and then identify final cases for Member outreach.
  
• 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 process.
  
• 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 needs.
  
• 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 Members.
  
• 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 denied.
  
• 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 policies.
  
  
  Supervisory Responsibilities
  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.
  Education Qualifications
  High School diploma or GED required.
  Preferred Education
  Bachelor's degree in Social Work from an accredited institution preferred.
  Professional Certification
  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.
  Professional Licenses
  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.
  Skills Requirement
  Strong computer skills in Microsoft Word and Excel, and comfortable with different technology CRM software. Excellent interpersonal, communication, and coordination skills.
  Abilities Requirement
  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 organization.
  Working Conditions
  Word processing and data entry involving computer keyboard and screens. Travel (drive) to many locations in Riverside and San Bernardino counties in California.
  Physical Requirements
  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 - CONSTANTLY
  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