Job Summary: This position is responsible for screening and patient eligibility for multi- programs offered at OFH such as Patient Protection, Affordable Care Act (ACA), Immigration Reform (IR), 3rd Party Payors, Family PACT, Every women counts, Sliding scale etc. The Patient Outreach and Enrollment Specialist are responsible for qualifying patients for financial coverage of services rendered. Patient Outreach and Enrollment Specialist (POES) services may include, but are not limited to, providing individuals and families with education about and assistance with the application process, case manage to ensure successful initial enrollments and annual renewal assistance. POES identify and develop relationships with strategic community partners (schools, service clubs, business, faith community, county staff, and other government agencies) and act as community liaison for OFH Outreach and Medi-Cal Retention programs. Represents OFH in the community and makes presentations at partner organizations and public forums regarding OFH outreach and enrollment initiatives. POES also establish and maintain relationships with County Departments of Social Services to facilitate applications and information sharing. The goal is to increase the number of individuals and families in California who are insured and have access to a Quality Health Plan.. Many patients are Spanish speakers and fluency in Spanish as well as familiarity with the regional Hispanic culture is required.
In addition, the ideal candidate must support mission and goal achievement, organizational quality and the patient-centered medical home philosophy we operate by. Incorporate core organizational values of quality, respect, integrity, partnership, and compassion in all activities and decisions. Perform community outreach and marketing to increase Omni Family Health (OFH) effectiveness in responding to the healthcare access needs of persons living in Kern County. Increase the number of area residents, especially those who qualify for the guidelines set by the Patient Protection and Affordable Care Act, who have access to primary and preventive health care services by identifying those eligible for publicly-sponsored insurance programs and other social services and assisting persons identified to navigate the enrollment process to secure needed services. Ensure that newly enrolled members of publicly-funded insurance programs understand how their insurance plan works and have a functional relationship with an appropriate primary care provider. Protect the dignity, privacy, and confidentiality of patients and their families, as well as co-workers and others.
Patient Outreach and Enrollment Specialist (POES) Tasks and Responsibilities (~75% of workload):
- Possess excellent communication skills to relate with diverse populations, and community organizations.
- Assist patients to accurately complete application(s) and successfully enroll/re-enroll into government sponsored health insurance programs or 3rd Party Payors, Family PACT, Sliding scale, Every Women countsetc.
- Demonstrated ability to manage databases and spreadsheets
- Demonstrated ability to work effectively with government and community partners
- Experienced in the use of protected health information (PHI) to comply with HIPAA rules
- Skilled in the use of personal computers and related software applications (MS Word, Excel, Access Database, and NextGen)
- Provide follow up on all pending applications to ensure enrollment process is complete.
- Provide Insurance and Medi-Cal financial counseling.
- Follow-up on Medi-Cal enrollment.
- Follow-up on Post-Enrollment management.
- Outreach to raise awareness of the availability of Quality Health Plans.
- Outreach to raise awareness of the availability and necessity of a Primary Care Provider.
- Provides information in a manner that is culturally and linguistically appropriate for consumers.
- Provide complete, fair and impartial information.
- Perform other duties as assigned.
- Collect and summarize process data from all HCN tasks.
- Assist in the collections of outcome data.
- Maintain and regularly update project database.
- Meet monthly face to face with the Patient Outreach and Enrollment Specialist (POES) Supervisor to report and review program progress.
- Maintain weekly communication with Patient Outreach and Enrollment Specialist (POES) Supervisor staff at OFH.
- Contact key personnel at Health Centers and other service/health-related organizations with access to target population to identify status or services and coordinate patient care.
- Possess strong interpersonal communication skills; is outgoing, very sensitive and aware of needs of public health clients who experience serious health problems and who have limited resources to address those health needs.
- Receives initial and ongoing program training.
- Receives regular technical support.
- Conduct trainings related to Outreach Program activities.
Planning and Program Development:
- Assists in conducting assessments of the community to identify availability of competing services, programs and organizations and institutions.
- Promotes the program in the community. Makes contact with all relevant healthcare facilities that might also provide diagnostic, treatment or social services to patients.
- Participate in planning discussions and meetings. Assist in developing tactical plans to support outreach and patient or payment goals.
- Prepare and submits daily/weekly productivity reports.
- Manage all aspects of the Patient Outreach and Enrollment Specialist (POES) Supervisor activities within the Health Center and in the community.
- Regularly update the project database and report to Patient Outreach and Enrollment Specialist (POES) Supervisor program coordinating staff.
- Provide database reports according to instructions from Patient Outreach and Enrollment Specialist (POES) Supervisor.
- Promote the program and materials as directed by the Patient Outreach and Enrollment Specialist (POES) Supervisor.
- Develop and maintain a database of healthcare and other enabling services available with data collection on availability and eligibility requirements for patient and client information.
Outreach Coordinator Task and Responsibilities (~25% of workload)
- Serve as a central resource for community questions and referrals for both consumers and providers, building relationships with community resources, public health, schools, churches, and other social service organizations to identify, refer and develop resources that remove consumer barriers to accessing needed health and social services;
- Identify individuals who qualify for Omni Family Health programs through direct outreach activities and through reports/referrals from community partners, churches, schools, internal data, and others;
- Connect with individuals to inform them about OFH services and related community resources and assist identified persons in accessing needed care that facilitates individual and family health, care coordination, continuity of care, and case management;
- Assist eligible clients to apply for publically sponsored health care insurance plans, providing necessary follow-up, tracking and data collection to assure continuous enrollment;
- Develop and maintain a tracking and follow-up system for Medi-Cal and other social service applications to ensure that all aspects of the process, from application through post-enrollment, have been completed and that the client is able to receive appropriate services;
- Maintain statistics/data on contacts; identify needs, problems and service gaps. Track and tabulate contacts, application submission and post-enrollment follow-up;
- Initiate post-enrollment support activities with Medi-Cal eligible clients, completing and recording the information required for monthly OFH reports;
- Attend appropriate community or networking meetings to facilitate outreach and gathering of information to increase consumer access to a permanent medical home;
- Work with local schools, churches, community partners, and key employers to train, coordinate and problem-solve so they can make appropriate referrals to OFH or appropriately support enrollment in or use of services through the Medi-Cal program;
- Develop with Marketing Partner, Supervisor, and Health Center Site Manager educational flyers/handouts to distribute through local community-based groups;
- Participate in community coalitions and related committees convened to maximize enrollment and education;
- Support and contribute to effective safety and risk management efforts by adhering to established policies and procedures, maintaining a safe environment, promoting accident prevention, and identifying and reporting potential liabilities; and
- Other related duties as assigned that support organizational goals and objectives and patient centered care.
- Bilingual required (English/Spanish or English/Punjabi)
- CAA Certification – preferred
- Periodic state travel; travel between Health Center sites
- Occasional evening or weekend work
Skills and Abilities
- Skill in exercising initiative, judgment, problem solving and decision-making
- Skill in the development and maintenance of effective relationship with medical and administrative staff, patients and the public
- Skill in gathering and analyzing objective and subjective data on personnel matters;
- Skill in conflict resolution
- Skill in identifying problems, recommend solutions, organize and analyze information
- Skill in organizing work, delegating and achieving goals and objectives
- Skill in operating a variety of office equipment and computer programs
- Skill to work under pressure, set priorities among multiple requests
- Skill to communicate and present information effectively
- Advance personal knowledge base by pursing continuing education to enhance professional development
- Non-judgmental attitude
- Ability to work independently and as part of a team
- Ability to plan, organize and integrate priorities and deadlines
- Ability to work at a rapid pace, being involved in several duties at one time
- Ability to set priorities and avoid crises management
- Ability to remain calm and poised in urgent situations
- Ability to communicate effectively in writing and verbally
- Excellent time management skills and flexibility
- Ability to report to work as scheduled
- Demonstrated skills/knowledge of Microsoft Office suite
- Ability to maintain confidentiality
- Language Skills: Bilingual (verbal & written) in English and Spanish. Any third language a plus (relative to community need – e.g. Tagalog, Vietnamese)
- Excellent customer service skills – ability to understand and exceed customer expectations while demonstrating the highest standards of care, respect, and confidentiality
- Basic computer skills
- Ability to relateeffectively with people of different cultural backgrounds
- Demonstrates positive interactions with the public, patients and children.
- Have positive interpersonal relations in dealing with fellow employees, and supervisors, so that productivity and positive employee relations are maximized.
- To assist clients in applying for appropriate health care coverage plans, providing necessary follow-up, tracking and data collection.
- Fluent in Spanish and English (able to read, write and speak in both English and Spanish). Familiar with the regional Hispanic culture.
Other Job Duties:
- I.P.A.A. compliance – Responsible for enforcing compliance with all H.I.P.A.A. regulations and requirements. Treats all member information confidential.
- Compliance – Ensure compliance with all local, state and federal regulations.
- QA/QI – Participate in QA/QI activities and contribute towards the overall performance improvement of the organization.
- IT – Required to learn and use the EHR/EOHR (Medical Practice Electronic System) and its components as required by the job functions and highlighted in the Policies and
- All employees will participate in Patient Centered Health Home Model at Omni Family Health.
Qualifications, Education, and Experience:
- High school diploma.
- BA/BS in social services or health education, public health or other health related field preferred.
- 1-3 years of experience in program development or other related field desired.
- Certified Application Assistance certification can substitute for 1 year of experience.
- Minimum two years working in a Primary Care Health Center, Healthcare related field, community or school based social service position. Work as a community health outreach worker and OHP enrollment specialist highly desirable.
- Personal commitment to the organization’s mission, vision and core values
- Personal commitment to the ACA, IR, and Patient-Center Medical Home philosophy
- Keyboarding at a minimum of 45 wpm
- Ability to pass a pre-employment drug screen and background test, Tb clearance
- Dependable motorized transportation, valid driver’s license and proof of auto insurance
- Knowledge of eligibility requirements and application process of all government sponsored health insurance programs
- Demonstrated organizational, work management, and group process skills, ability to take initiative to identify and propose new tasks and procedures
- Ability to establish and maintain working relationships with a diverse group of staff, public and professionals
- Ability to manage time and prioritize tasks
- Ability to proofread and edit for accuracy, punctuation, grammar, spelling, and clarity
- Demonstrated knowledge and competence in the use of software applications: word processing, spreadsheet, presentation, email applications (Microsoft Office preferred)
- Communication skills and the ability to work independently and collaboratively as needed
- Ability to travel to work outreach and enrollment sites as required– must have reliable transportation
- Current working experience in a Community Health Center setting
- Must be able to maintain a good attendance record
- Knowledge of Kern County health care system preferred
Responsible To: Healthcare Navigator and Outreach Supervisor
Classification: Full Time Position, Non-Exempt