Job Description

For more details, please connect with Ibad Ullah Khan at 971-431-1753 or email at ibadk@vgroupinc.com

Client: Healthcare

Job Title: Healthcare Eligibility / Enrollment Specialist/Program Assistant

Duration: 06+ Months

Start Date: ASAP

Location: 505 City Parkway West, Orange CA 92868 (100% Onsite)

Position Type: Contract

Interview Type: In Person/Web Interview

Department: Department of Customer Service

Description:

• CalOptima Health is seeking a highly motivated an experienced Program Assistant (Enrollment - Medi-Cal) to join our team. The Program Assistant (Enrollment - Medi-Cal) will provide assistance with specialized services for Medi-Cal eligible members, including data reporting, analysis and reconciliation. The incumbent will be responsible for maintaining eligibility accuracy by monitoring, updating and reviewing the current Medi-Cal program requirements.

Duties & Responsibilities:

95% - Program Support

• Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
• Coordinates specialized processes, including eligibility analysis, strategic provider assignments, age restriction and complex condition member administration/monitoring and floor audits for the Medi-Cal program.
• Assists with completing various members requests, such as Change of Health Network Requests, primary care provider (PCP) change requests and data correction forms.
• Responds to questions and interprets policies and regulations.
• Prepares materials (e.g., letters/surveys, etc.) and coordinates data files to arrange for mail merge of materials as applicable.
• Assists with ensuring processes are accurate and compliant with the regulatory requirements by maintaining and documenting process workflows, desktop procedures and policies.
• Represents the Medi-Cal program on projects or as a liaison within or outside CalOptima Health.
• Facilitates communication on specialized topics.
• Prepares reports and creates reporting tools; performs special reconciliation procedures, including Excel sorts and mergers, filters and compiling reports and Access database procedures.
• Acts as liaison between the Enrollment department and other Customer Service staff.
• Supports with quality assurance audits to validate the accuracy of Protected Health Information / Appointment of Representative (PHI/AOR) and Acceptance Letter updates processed by other staff members.
• Conducts outreaches to members and health insurance carriers to verify potential Other Health Coverage (OHC)
• Assists with processing member surveys submitted by modifying members profiles with demographic, other health coverage and address changes.

5% - Other

• Completes other projects and duties as assigned.

Minimum Qualifications:

• High school diploma or equivalent PLUS 1 year of experience of eligibility and/or reconciliation required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications:

• Health insurance experience (Medi-Cal).
• Prior experience interacting with regulatory agencies, including Department Health Care Services (DHCS) and Department of Managed Health Care (DMHC) and practices related to Medi-Cal.
• Experience in a Health Maintenance Organization (HMO), managed care or Medi-Cal setting.
• Customer Service experience.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).

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