HCBA Enrollment Specialist

Position Summary: As a member of the Home and Community Based Alternatives (HCBA) Medi-Cal Waiver Team, reporting to the HCBA Medi-Cal Waiver Program Supervisor, the Enrollment Specialist is responsible for assisting HCBA Care Management Teams (CMT’s) with timely application processing, accurate documentation of case status through applicant enrollment, and follow up of Care Management documentation, to ensure participant retention and engagement in accordance with the HCBA Medi-Cal Waiver program. The Enrollment Specialist is responsible for assisting HCBA Care Management Teams (CMT’s) and Referrals Coordinator with the enrollment of Waiver Personal Care Providers (Individual Providers) and HCBA Waiver service providers, such as Public Authority (PA), In Home Support Services (IHSS), Department of Health Care Services (DHCS) Waiver Personal Care Services (WPCS) Unit, Home Health Agencies (HHA), Personal Care Agencies (PCA) and Independent Nurse Providers (INP). The Enrollment Specialist is the primary liaison between potential beneficiaries, potential new service providers and the HCBA Waiver Program. The Enrollment Specialist should have excellent time management and communication skills, as he/she will create and deliver educational materials for medical providers and other community resources via presentations, collaborate with clients, family members/caregivers, service providers, internal and external teams to deliver enrollment results. Essential Functions of the Job: Receives notification of interest for HCBA Medi-Cal Waiver program enrollment from Toll-Free number, Transition of Care documentation, referral form, fax line, e-mail, mail, and/or external facilities. Answer/Return phone calls in a prompt, professional and courteous manner. Checks HCBA Medi-Cal Waiver program eligibility requirements for applicants, including Medi-Cal insurance eligibility. Conducts Care Management programs eligibility screening, intake, education, and enrollment assistance activities to initially determine participant needs and eligibility for enrollment. Ensuring that HCBA Waiver applications are completed correctly and that the required supporting materials have been provided. Participates in outreach events and community activities in conjunction with and as assigned by the Program Supervisor and/or Program Manager. Participates in outreach virtual/in-person presentations with different organizations to share the HCBA Waiver Program. Manage the HCBA Waiver program information by presenting information, utilizing available media, group presentations, mailing and others. Tracks, monitors, and reviews program availability or waitlist status for potential participants. Assigns a Care Management Team to the potential participants, schedules the initial assessment, and keeps track of upcoming appointments. Requests/receives participant records from Primary Care Provider (PCP) or works with the potential participant or their circle of support to establish a PCP. Obtains Community Based Care Management program documentation from DHCS, CMTs, San Diego County and other organizations via phone, writing, or electronic media. In addition, follows-up on missing documentation to obtain case enrollment approval or scheduling when appropriate. Responds to inquiries as to current status of authorization by assessing the request and evaluating the circumstances to provide the correct information. Reviews, tracks, and monitor Medi-Cal and Community Based Care Management program continued eligibility for enrolled patients and service providers. Files, uploads and keeps up to date assigned client’s files. Uses various computer systems to obtain information, schedule appointments, query information, and obtain patient documentation. Provides data entry and report generation as needed. Maintains and collects data from referral, intake, enrollment, marketing, and outreach activities and submits pertinent reports by due dates. Review, track and process State…