Insurance Eligibility Specialist Community Health Worker (CHW)

Welcoming all who need care

Job title 

Community Health Worker - Insurance Enrollment Specialist (IES)

Reports to 

Director of Patient Engagement

Status 

Non-Exempt (Hourly)

Job purpose 

The Insurance Enrollment Specialist (IES) plays a crucial role in the healthcare system. The primary responsibility is to guide individuals through the insurance enrollment process. The Insurance Enrollment Specialist will handle applications, collect information, provide advice, and determine 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. The Insurance Enrollment Specialist provides unbiased enrollment assistance and community outreach.

Duties and responsibilities 

• Customer Guidance: They assist individuals in understanding the enrollment requirements, procedures, and options available. This involves explaining eligibility criteria, application processes, and required documentation.

• Resource Navigation: The IES will evaluate other unmet needs and work to connect patients with resources such as food pantries, employer assistance programs and utility assistance.

• Application Processing: They 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.

• Communication: Enrollment Specialists 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.

• Education: Health insurance and using health care services can be confusing. The IES will 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. Increasing awareness among the remaining uninsured about the coverage options available to them, helping consumers find affordable coverage that meets their needs

• Compliance and Regulations: They must stay updated on relevant regulations, policies, and compliance standards to ensure adherence to legal requirements throughout the enrollment process.

• Problem Resolution: Addressing issues that arise during enrollment, such as missing information, discrepancies, or technical problems, is a significant part of the role. They work to resolve these efficiently and effectively.

• Documentation and Reporting: Maintaining accurate records, generating reports, and tracking enrollment data is often part of the responsibilities. This helps in assessing enrollment trends and identifying areas for improvement. Documents pertinent information in electronic medical record.

• Collaboration: Enrollment Specialists may 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.

• Quality Improvement: They may participate in the development and implementation of strategies to enhance the enrollment experience, streamline processes, and increase enrollment rates.

• Performs other duties as assigned.

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.
• Knowledge of health insurance programs, regulations, and policies.
• Strong interpersonal and communication skills.
• Detail-oriented with excellent organizational and time management abilities.
• Proficient in using relevant computer applications and databases.
• Demonstrated commitment to promoting diversity, equity, and inclusion.
• Community Health Worker Certifications will be obtained once hired.

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.
• 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-5:00PM (as needed) (average 40 hours/week)
• Location: All Heartland Locations
  • Schedule may be altered by supervisor(s) as needed to allow for completion of expected duties of the position.