Responsible for educating senior patients on Medicare, Medicare Saving Programs (MSP), providing resources to applicable patients, determining eligibility of patients for MSPs, processing enrollment applications for applicable programs, and attending applicable outreach events. Individual will facilitate consumer enrollment and assist qualified individuals in making informed decisions on the selection of Medicare options and MSPs, if available. The Medicare Enrollment Specialist will provide services to all consumers, including but not limited to, CommuniCare patients and area residents 60 years and older, particularly residents under-represented and those uninsured. Ensures patient accounts are managed that include assisting patients with account summarization. Connects patients to CommuniCare’s Medicare Advantage partner, when ready. The Medicare Enrollment Specialist will be required to complete 12 hours of approved training annually to stay up-to-date on all Medicare guidelines and regulations, as well as to be able to provide the most accurate assistance to patients.

DUTIES AND RESPONSIBILITIES:

1. Performs screenings on patients that are near Medicare eligible to ensure seamless process to receiving Medicare and to check for eligibility in various Medicare Savings Programs available through the state; this includes predetermination and assistance with application completion; accurately places clients on appropriate programs based on funding source requirements; after enrolling into Medicare and MSPs, refers patients to the Medicare Advantage worker.

2. Maintain knowledge and expertise in eligibility, enrollment, and program specifications of Medicare and Medicare Savings Programs.

3. Conduct in-reach, outreach and education activities to inform CommuniCare patients, consumers, businesses, community organizations and other stakeholders about Medicare and all ancillary Medicare programs to encourage participation.

4. Performs follow-up eligibility process to include contacting patient for additional information and contacting the funding source for eligibility status.

5. Ensure the protection and security of a consumer’s personal, confidential and identifiable information in a professional and responsible manner, according to the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA).

6. Conduct in-person, scheduled meetings with patients and/or family members to provide education and resources on available Medicare insurance plans and complete applications, as applicable.

7. Ensures accurate activations of plans and programs and records special notations in patient account software; assists patient with registration.

8. Plans and executes a quarterly Medicare Education Session for all patients and area residents with the full Medicare Enrollment Team.

9. Provides excellent internal/external customer service via telephone, fax or face-to-face contact to assist patients with their health care needs.

10. Maintains daily log sheet/template of all activities performed in determining volume of work, grant productivity numbers, account balance arrangements, new patient registrations and any other assistance provided by the staff; submits logs to the department manager for review.

11. Performs other related duties as assigned.

JOB QUALIFICATIONS:

High School diploma or equivalent

Minimum two (2) years’ experience working with Medicare and Medicare population

Bilingual in English/Spanish, required

Working knowledge of Medicare, Texas Medicare Savings Programs, and understanding of Medicare Advantage plans

Computer skills; Word, Excel, Internet/Intranet

Scheduled hours and/or work locations are subject to change

PHYSICAL ACTIVITIES AND REQUIREMENTS:

Finger Dexterity: Using fingers to make small movements such as typing or picking up small objects.

Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.

Hearing: Able to hear average or normal conversations and receive ordinary information.

Repetitive Motions: Frequently and regularly using the wrists, hands, and fingers.

Visual: Average, ordinary, visual acuity necessary to prepare or inspect documents or other materials.

Physical: Physical work involving bending, stooping, and reaching high areas for charts; excessive walking and standing most of the time. May have to lift folders, files, papers, and other such items weighing up to approximately 25 lbs.

Education

• High School/GED or better in General Business

Skills

• English
• Spanish