Enrollment Analyst

Job description

·  Job Description:

Job Description

Position Purpose:

The purpose of the PCMH (patient center medical home) Enrollment Analyst position is to support Hometown Health with the evaluation of the adequacy and effectiveness of internal processes, information systems, controls, risk management, and governance for Medicaid requirements.  This position will manage the PCMH enrollment for all primary care physicians participating in the program. You will process the applications and communicate directly with the providers to correct or submit the necessary documentation for their enrollment annually.  The analyst will process documents throughout the year for changes to their enrollment.  This position will work closely with internal and external candidates providing details to the current status of PCMH enrollment.

KNOWLEDGE, SKILLS & ABILITIES :

1. General knowledge of Health Insurance

2. The position requires the ability to recognize and research the existence of current or potential problems and perform related audits in the following areas: standards, procedures, and techniques; clinical principles and techniques; management principles and deviations from good business practices; and fundamentals of business.

3. The position requires ongoing, clear communication in with staff and leaders in all departments regarding project objectives, evaluations, conclusions, and recommendations, including leading non-subordinates to the common goal of improved performance measures. Effective and collaborative working relationships with internal and external stakeholders must be maintained. The position may be responsible for providing input to leadership regarding overall enrollment performance relative to PCMH enrollment.

4. The incumbent must be able to prioritize, initiate and manage PCMH enrollment using specific, goal-oriented action and project plans that are accurate, timely, and meaningful. The plans require defining needed process, technology, or people changes, guiding and monitoring cross-functional teams, and outreach to vendors or providers when necessary.

5. Ability to design, develop, and maintain documents, logs, and spreadsheets, including appropriately securing and handling any related confidential files and information.

6. Strict adherence of rules and regulations for confidentiality and compliance.

7. Ability to review and understand the different providers types enrolling in PCMH enrollment.

8. Demonstrate strong attention to detail and organizational skills.

9. Excellent oral and written communications skills.

10. Ability to work independently or as part of a self-directed work team.

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

QUALIFICATIONS
Required:

·  Bachelor’s degree and three years of experience assisting clients with complex issues and service needs, in a social service, healthcare, or health insurance setting. Additional experience may substitute, year for year, for education.
·  Ability to maintain high level of confidentiality.
·  Ability to communicate effectively, both orally and in writing, regarding complex or sensitive information or issues.
·  Demonstrated ability to earn the trust, respect, and confidence of co-workers, carriers and customers through consistent honesty, forthrightness, responsibility and professionalism in all interactions.
·  Strong interpersonal skills; ability to work with diverse client populations, as well as all levels of internal management and staff.
·  Must have working-level knowledge of the English language, including reading, writing and speaking English.
·  Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete enrollment, etc. Typing 35 WPM.

Desired:

·  Experience working in the public sector.
·  Broad knowledge and understanding of the health care industry, including the commercial insurance market, Medicaid, or other health delivery systems.
·  Motivated self-starter with initiative to take independent action and accept responsibility for your actions.
·  Well organized, flexible, proactive, resourceful and efficient with strong attention to detail.