SUMMARY: The Eligibility and Enrollment Specialist- Lead (EES) will be responsible for increasing access to medical care through application and enrollment assistance for homeless children and adults. The EES Lead will provide outreach and education to patients regarding mental health services available at CFH and in the community, and they will strengthen enrollment collaborations with partner organizations. This employee will work as part of the PCMH team. Eligibility and Enrollment Lead is based on patient care needs and scope of the practice and follows the principles of Trauma Informed Care.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

Outreach

• Outreach to uninsured patients at CFH by phone, mail, or in-person to promote health insurance enrollment.


• Document outreach encounters in eClinical Works using telephone encounters.


• Provide structured patient education on Medicaid and other insurance eligibility.


• Develop and distribute appropriate outreach materials to patients and partner organizations to increase insurance coverage option awareness and applicable Affordable Care Act (ACA) provisions.


• Travel within CFH health centers to provide insurance enrollment, as required.

 

Health Insurance Enrollment

• Provide insurance enrollment assistance for uninsured and underinsured patients, including but not limited to completing applications, gathering required documentation, and troubleshooting the enrollment process.


• Utilize health insurance verification systems such as ePaces, Claim Remedi and EBO reports to verify health insurance information.


• Work with NY State of health Marketplace to submit applications, client’s documents, and file complaints, as necessary.


• Document insurance application encounters in eClinical Works.


• Collaborate with partner organizations to increase enrollment in Medicaid, Medicare, and other health insurance.


• Attend and successfully complete all required training programs and participate in on-going training and webinars, as necessary.


• Assist in the development and implementation of organizational outreach and enrollment initiatives.


• Perform additional duties, as required.

 

Mental Health Services

• Educate patients in mental health services available within CFH, and beyond.


• Refer patients in need of mental health services to a mental health provider at CFH and in the community.


• Search for organizations and programs based on clients’ needs.

 

Lead Responsibilities:

• Conduct regular and ad hoc site visits to assigned locations to assess workflows, identify gaps, and provide real-time support to the Eligibility and Enrollment team.


• Provide ongoing in-person support to staff by answering questions related to enrollments, reinforcing workflows, and offering real-time guidance.


• Support the onboarding and training of new and existing Enrollment Specialists on the NY State of Health Marketplace, workflows, systems, and best practices.


• Identify operational challenges affecting the team and escalate concerns to the Health Services Administrator with recommendations for improvement.


• Monitor and promote consistency in documentation, including insurance verification and enrollment.


• Monitor team data and maintain tracking systems to assess progress toward grant deliverables and team goals.


• Support the preparation and submission of data reports to senior leadership and funders, ensuring accuracy and timeliness.


• Collaborate with the Health Services Administrator to develop health insurance training materials, including manuals, videos, and other resources.


• Assist with the ordering and distribution of incentives for the Eligibility and Enrollment team.


• Perform other duties as assigned.