Title: Program Assistant - Medi-Cal Enrollment
Duration: up to 6 months
Schedule: Monday-Friday 8a-5pm
Location: Orange, CA
Compensation: $23.92-$33.49/hour
Description: 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.
What You Will Do: - Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
- ssists 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.
- ssists 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.
- ssists 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 of health plan.
- 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.
- cts 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)
- ssists with processing member surveys submitted by modifying members profiles with demographic, other health coverage and address changes.
- Completes other projects and duties as assigned.
You Will Be Successful If: - Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem-solve and possess project management skills.
- Work in a fast-paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi-program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Excel, Outlook, PowerPoint, Word) and job-specific applications/systems to produce correspondence, charts, spreadsheets and/or other information applicable to the position assignment
What You Will Bring: - High school diploma or equivalent
- 1+ year of experience in eligibility and/or reconciliation required
- Health insurance experience (Medi-Cal) preferred
- 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 preferred
- Experience in a Health Maintenance Organization (HMO), managed care or Medi-Cal setting and Customer Service experience preferred
- Bilingual in English and one of the following languages preferred: Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese
bout Impresiv Health: Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
That's Impresiv.