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Outreach & Enrollment Advisor

Date: Apr 18, 2021

Location: Rancho Cucamonga, CA, US

Company: Inland Empire Health Plans

Job Requisition ID: 4757 

 

Position Summary/Position

 

Under the direction of the Enrollment Assistance Manager, the Outreach and 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 and 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 and 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 and 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.
2. 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.
3. Partner with multiple departments, including Medical Directors, Healthcare Informatics, Finance, and other applicable departments to collect a full evidence set for the application. 
4. Review the full evidence set and thoroughly assess Members’ potential eligibility for Medicare, SSI and/or SSDI benefits.
5. Screen all potential cases and then identify final cases for Member outreach.
6. 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.
7. Fully explain the Medicare, SSI and/or SSDI benefits to the Members to obtain their agreement to participate in the application process.
8. Work with the eligible Members to complete a full application and explain all future steps.
9. Organize all logistics required for the entire application process, including interpreter services and transportation needs.
10. Provide hands-on assistance to the Members including making appointments with Members’ Doctor, the Social Security Administration offices, or the county Medi-Cal offices.
11. Conduct field activities, including accompanying with the Members to all appointments (e.g., the Doctor and Social Security Administration offices) if requested.
12. Submit the application to the agency if requested by the Members.
13. Actively monitor the process after the application is submitted and provide all assistance that the Members need.
14. Conduct all follow-ups needed during the entire application process until the application is processed and approved or denied.
15. Actively build a relationship with the county Medi-Cal offices, Social Security Administration offices and other key agencies to achieve the program’s objectives.
16. Follow all applicable regulatory guidelines and IEHP’s policies.

Supervisory Responsibilities

Leading: Self

Experience 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 - FREQUENTLY
Keyboarding: Traditional - FREQUENTLY
Keyboarding: 10-Key - FREQUENTLY
Keyboarding: Touch-Screen - FREQUENTLY
Keyboarding: Other - FREQUENTLY
Use of computer mouse - FREQUENTLY
Hearing: One-on-One - FREQUENTLY
Hearing: In a group - FREQUENTLY
Hearing: Over the Telephone/Cell Phone - FREQUENTLY
Hearing: Conference Speakers/Video Calls/Radio Calls - FREQUENTLY
Communicate: Information/ideas verbally - FREQUENTLY
Communicate: Verbally engage with customer base - FREQUENTLY
Communicate: Give instructions, advise, warn, instruct - FREQUENTLY
Far Visual Acuity - FREQUENTLY
Near Visual Acuity - FREQUENTLY
Perform complex and varied tasks - FREQUENTLY
Develop and maintain positive work relationships - CONSTANTLY
Adaptability: rate of change in work location - FREQUENTLY
Simple Grasp - FREQUENTLY
Standing - FREQUENTLY
Walking - FREQUENTLY
Sitting - FREQUENTLY
Indoors - FREQUENTLY
Outdoors - FREQUENTLY
Lighting - CONSTANTLY
Traffic - FREQUENTLY
Adaptability: rate of change in work tasks - FREQUENTLY
Regular contacts: co-workers, supervisor - FREQUENTLY
Regular contacts: recurring clients - FREQUENTLY
Other contacts: public exchange - FREQUENTLY
Decision-making - FREQUENTLY
Lead/Influence Others - FREQUENTLY
Work review - FREQUENTLY
Rapid Pace of work - FREQUENTLY
Control of work place - FREQUENTLY
Pace of work with faster/slower work periods - FREQUENTLY
Problem Solving - FREQUENTLY
Memory - FREQUENTLY
Understand and follow direction - FREQUENTLY
Regular and reliable attendance - CONSTANTLY

 

Starting Salary: $57,948.80  - $73,860.80  

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