Job description

Job Summary

Under the general supervision of the Director of Operations, or designee, this full-time position will assist individuals with determining their eligibility for the Genesee Health Plan (GHP), Michigan Medicaid Programs, the Affordable Care Act (ACA) Insurance Marketplace, Michigan Medicare/Medicaid Assistance Program (MMAP) or GHP Dental Programs. If an individual is found eligible, the Enrollment Specialist will assist with education and enrollment into the appropriate insurance plan(s). The Enrollment Specialist will interact with Third Party Administrator or Delta Dental Customer Service and other Enrollment staff when questions or issues arise. This position may re-enroll GHP members who have been a past member for one year and still qualifies for the Plan, if the individual is not eligible for any other insurance program. If an individual does not qualify for GHP, this position will link the person to community resources, other safety-net providers and other health insurance coverage.

Principal Duties and Responsibilities

• Following Centers for Medicare and Medicaid Services (CMS) and using GHP-approved enrollment criteria and guidelines, gathers needed documentation from the applicant, reviews the documentation and determines whether the applicant is eligible or ineligible for GHP Plan enrollment, Michigan Medicaid Program enrollment, insurance enrollment through the Marketplace, MMAP or GHP’s Dental Plan enrollment.

• Assists the applicant with completing necessary electronic or paper forms and keeps accurate records of all documentation and enrollment forms, in accordance with federal, state and agency guidelines.

• If an individual is not deemed eligible for enrollment in the insurance Marketplace, provides assistance with linking to safety-net providers, other community resources, and other health insurance coverage through the GHP or the Michigan Medicaid Programs.

• If an individual is deemed eligible for GHP, or the GHP Dental Plan enrollment, is responsible for processing the enrollment application in the GHP electronic data management system.

• Only individuals who meet the criteria (income FPL and proof of Marketplace insurance premium payment) will be eligible to apply for coverage under GHP’s Dental Program.

• Expedites applications requiring immediate enrollment.

• Reviews the GHP Member Handbook with the enrollee, educating on the Plan’s coverage and co-pays.

• Provides education to the community about the Health Plan.

• Re-enrolls former members, if deemed eligible.

• Provides support during community education and enrollment sessions.

• Enters statistical data from surveys for tracking disease management and member satisfaction into the GHP electronic data management system.

• Participates in orientation, training sessions and staff meetings, as directed.

• Maintains confidentiality of member’s health information, in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

• Maintains effective and quality interpersonal relationships with members, their family members, physicians, and co-workers.

• Acts as an advocate for individuals and families with pharmaceutical companies, safety net providers, community resources, etc.

• Coordinate service provision with Third Party Administrator and/or other benefit providers.

• Attends Health Plan-related meetings, as requested by the Director of Operations, or designee.

• Performs other duties, as assigned. Qualifications:

• Associate or Bachelor’s degree in the Human Services and/or Health-related programs preferred, but not required.

• At least 1 year of experience and expertise in the medical field, including knowledge of medications, health coverage, and other medical benefits preferred.

• Certification as a Certified Application Counselor (CAC), preferred. If not certified, must complete CAC training within 10 working days of hire.

• Must complete MI-Bridges and MMAP training within 30 days of hire.

• Effective communication skills and ability to make presentations.

• Previous experience working collaboratively with physicians, health care providers and social service agencies.

• Proficient computer skills, including Word, and Microsoft Excel.

• Strong desire to help others.

• Communicates and relates well with individuals in the community and provides advocacy role for individuals.

• Experience working with culturally diverse and senior populations.

• Ability to speak Spanish helpful but not required.

• Is a good listener, non-judgmental, flexible and able to deal with complex situations.

• Demonstrated independent problem-solving ability.

• Willing to work a flexible schedule and travel to various locations throughout Genesee County.

• Valid driver’s license and proof of automobile insurance.

Physical Requirements

This position involves sitting most of the time and/or being mobile or standing for brief periods of time. Additional requirements include the ability to move objects according to the following weight and frequency: generally, 10 pounds of force up to one third of the time.

Genesee Health Plan is a 501(c)3 designated non-profit organization that is an Equal Opportunity employer committed to a workforce that is diverse and inclusive

Job Type: Full-time

Pay: From $16.00 per hour

Benefits:

• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: One location

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