Enrollment Specialist

APLA Health’s mission is to achieve health care equity and promote well-being for the LGBT and other underserved communities and people living with and affected by HIV. We are a nonprofit, federally qualified health center serving more than 14,000 people annually. We provide 20 different services from 15 locations throughout Los Angeles County, including: medical, dental, and behavioral health care; PrEP counseling and management; health education and HIV prevention; and STD screening and treatment. For people living with HIV, we offer housing support; benefits counseling; home health care; and the Vance North Necessities of Life Program food pantries; among several other critically needed services. Additionally, we are leaders in advocating for policy and legislation that positively impacts the LGBT and HIV communities, provide capacity-building assistance to health departments across the country, and conduct community-based research on issues affecting the communities we serve. For more information, please visit us at aplahealth.org.

 We offer great benefits, competitive pay, and great working environment! 

We offer:

• Medical Insurance
• Dental Insurance (no cost for employee)
• Vision Insurance (no cost for employee)
• Long Term Disability
• Group Term Life and AD&D Insurance
• Employee Assistance Program
• Flexible Spending Accounts
• 12 Paid Holidays
• 3 Personal Days
• 10 Vacation Days
• 12 Sick Days
• Metro reimbursement or free parking
• Employer Matched 403b Retirement Plan

This is a great opportunity to make a difference!

This position will pay $23.92 – $28.45/hr.  Salary is commensurate with experience.

POSITION SUMMARY:

Under the direction of the Enrollment & Eligibility Manager, and in accordance with HRSA contract requirements, the Enrollment Specialist II assists clients, either directly or through referral, with enrollment/re-enrollment in Covered CA, Medi-Cal, Medicare, and MHLA, as well as with the process of accessing Public Benefits.                                                              

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Screen clients using PointCare for eligibility in and assist with enrollment/re-enrollment in Covered CA, Medi-Cal, Medicare, MHLA, commercial products, Ryan White, ADAP, PrEP-AP as well as with the process of accessing Public Benefits.
• Serve as the APLA Health & Wellness point of contact for addressing issues related to health plans that are part of independent physicians associations (IPAs) that APLAHW contracts with, including, but not limited to Health Care LA IPA and Regal Medical Group.
• Documents contacts and maintains files, utilizing Point Care for enrollment allowing them to accurately qualify and enroll patients into coverage, faster.
• Assist Enrollment & Eligibility Manager with training for new staff when requested.
• Provides support for questions from Enrollment Specialists I and other clinic staff in the absence of the Enrollment & Eligibility Manager.
• Responsible to provide access to Health Plan provider logins to staff so they can check patient's eligibility, coverage and check claim status. 
• Stay current with APLA Health programs.
• Follow up to verify the status of enrollment applications and assist clients who are experiencing problems.
• Complete a comprehensive benefits and qualified health insurance assessment for each client.
• Maintain and update all client records via eClinicalWorks electronic health record system and reviews to verify and ensure data entered are accurate.
• Answer and respond to incoming telephone calls and emails regarding eligibility in qualified health plans and Public Benefits according to agency policy.
• Describe what a summary of benefits document is and where to locate a summary of benefits. Explain where to find information about provider networks.
• Answer and respond to incoming telephone calls and emails regarding eligibility in qualified health plans and Public Benefits according to APLA Health & Wellness.
• Collaborate with other programs at APLA Health & Wellness and other service organizations to facilitate the provision of services.
• Maintain an extensive awareness of client resources, both agency-wide and Federally Qualified community based healthcare organization (FQHC).
• Attend relevant trainings relating to benefits programs such as My Health LA, and trainings required to meet contract requirements.
• Prepare reports and client records as required to meet APLA Health & Wellness, city, state, and federal program requirements.
• Follow agency policies and maintain agency standards with regards to client confidentiality and HIPAA compliance.                                                                                   

OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.

REQUIREMENTS:

Training and Experience:

A high school diploma and at least five years’ experience in benefits enrollment, or an AA degree and a minimum of two years’ experience in benefits enrollment. Must be trained as a Medi-Cal Enroller, Covered CA Certified Enrollment Counselor (CEC) and ADAP/OA HIPP/PrEP-AP Enroller or acquire these certifications within six (6) months of hire. A proficiency in writing, proofreading and grammar skills is important, as well as interpersonal customer service skills. Bilingual Spanish/English required.

Knowledge of:

Interviewing and assessment techniques; vocational rehabilitation and/or related occupational fields, knowledge of word processing and eClinicalWorks electronic health records data entry; HIV disease and related chronic illness and disability issues; comprehensive understanding of public benefits programs and policies; qualified health plans, including, but not limited to Covered CA, Medi-Cal, and Medicare, My Health LA and Ryan White. Must have knowledge of the healthcare field.  

Ability to:

Work under minimal supervision; assess psychosocial and occupational/vocational needs; utilize agency and community resources; communicate effectively (orally and in writing) in both one-on-one and public settings; respond with empathy to the needs of clients, staff and volunteers; participate as a member of a team operating in a diverse, multi-cultural environment.

WORKING CONDITIONS/PHYSICAL REQUIREMENTS:

This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.

SPECIAL REQUIREMENTS:

Must possess a valid California driver’s license; proof of auto liability insurance; and have the use of a personal vehicle for work related purposes.

COVID-19 Vaccination and Booster or Medical/ Religious Exemption required.

An Equal Opportunity Employer: minority/ female/transgender/ disability/ veteran 

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