Insurance Enrollment Specialist

Job title

Insurance Enrollment Specialist (IES)

Reports to

Director of Patient Engagement

Status

Non-Exempt (Hourly)

Job Purpose

The Insurance Enrollment Specialist (IES) is responsible for guiding individuals through the insurance enrollment process. The Insurance Enrollment Specialist will oversee and supervise the IE Community Health Workers (CHWs) in processing applications, collecting information, providing insurance eligibility education, and determining the patients’ eligibility for insurance coverage and other enabling programs.

The Insurance Enrollment Specialist will be skilled at assessing and screening patients for specific KS Medicaid, Medicare and Marketplace plans and programs. They will be able to make recommendations, help patients navigate the enrollment process and maintain meticulous records. An outstanding candidate will demonstrate exceptional communication skills and detail-oriented work. This role demands strong interpersonal skills, attention to detail, organization, and the ability to navigate complex information while providing excellent customer service.

This role will also offer healthcare system education to help families know how to utilize their benefits and access Heartlands integrated services as well as other service providers. The Insurance Enrollment Specialist will also provide additional social service resources to improve their daily lives and mitigate barriers to care.

Duties and Responsibilities

• Assist individuals in understanding the enrollment requirements, procedures, and options available. This involves explaining eligibility criteria, application processes, and required documentation.
• Evaluate other unmet needs and work to connect patients with resources such as food pantries, employer assistance programs and utility assistance.
• Collect, review, and process enrollment applications, ensuring all necessary information is complete and accurate. This may involve data entry, verification, and coordination with other departments or agencies. The IES will help patients determine what health insurance programs they are eligible for and walk patients through the application process.
• Serve as a point of contact for inquiries, providing information via phone, email, or in-person meetings. Clear communication about deadlines, requirements, and procedures is essential.

• Provide one-on-one and group education about health insurance along with how to access care. The IES may also provide outreach and education at community sites and agencies, health fairs and events.

• Stay updated on relevant regulations, policies, and compliance standards to ensure adherence to legal requirements throughout the enrollment process.

• Addresses issues that arise during enrollment, such as missing information, discrepancies, or technical problems, is a significant part of the role.

• Maintain accurate records, generating reports, and tracking enrollment data is often part of the responsibilities. Documents pertinent information in electronic medical record.

• Collaborate with other departments, such as front office, finance and billing, and Community Health Workers, to streamline processes and provide comprehensive support to enrollees. Participates in external meetings, trainings and work groups to build effective relationships and partnerships; shares information and promotes Heartland services.

• Participate in the development and implementation of strategies to enhance enrollment experience, streamline processes, and increase enrollment rates.

Qualifications

• High school diploma or equivalent; bachelor’s degree in a related field preferred.
• Experience in healthcare administration, insurance enrollment, or a related field preferred.
• Computer skills to navigate Electronic Health Record software; eCW experience preferred
• Federally Qualified Health Center or public health experience preferred

Working conditions

• This role requires movement throughout the building day or multiple locations during the day.

• This role may be exposed to infections and contagious diseases.

• This role is subject to interruptions.

• This role requires management of personnel and procedures in a high stress environment.

• This role completes tasks that are performed in close physical proximity to other people.

• This role requires working indoors in environmentally controlled conditions.

Physical Requirements

• Moves equipment weighing up to 50 pounds.

• Moves throughout the building to meet with employees, patients, or visitors.

• Must be able to remain in a stationary position during shift.

• Ability to read, write, and speak English.

• Frequent communication with patients about their experience at the health center. Must be able to exchange accurate information in these situations.

• Operate a computer and other office equipment, such as tablets, scanners, printers, and phones.

• Adhere to process protocol or procedures.

Details

• Schedule: Full-time exempt.
  • Hours Mon-Friday 8:00AM-7:00PM (as needed) (average 40 hours/week)
• Location: All locations Heartland Community Health Center
  • Schedule may be altered by supervisor(s) as needed to allow for completion of expected duties of the position.