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Job Description

Job DescriptionThe Program Assistant (Enrollment Medicare) will assist with the specialized services for Medicare dual eligible members including data reporting, analysis and reconciliation. The incumbent will focus on member retention through accurate and timely resolution of issues and functions with minimal direction. The incumbent will prioritize daily tasks and work items in queue, manage turnaround times and manage items that require escalation. The incumbent will partner cross-functionally with various operational business units while supporting CalOptima Health’s departmental objectives and regulatory guidelines. In addition, the incumbent will be responsible for complex and escalated enrollment and disenrollment tasks.

Position Information:

• Department: CS - Enrollment Reconciliation & Member Communications
• Compensation: $23.92 - $33.48
• Work Arrangement: Full Office
• Work Schedule: Monday through Friday, 8:00 a.m. to 5:00 p.m.
• Expected Assignment Duration: up to six (6) months

Duties & Responsibilities:

• 95% - Program Support
  • Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists 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 for the program.
  • Answers all questions and interprets policies and regulations.
  • Develops materials, prepares and coordinates data for reports.
  • Ensures processes are accurate and compliant with the regulatory requirements by maintaining and documenting process workflows, desktop procedures and policies.
  • Represents the program on projects and acts a liaison within or outside CalOptima Health.
  • Facilitates communication on specialized topics.
  • Prepares reports and creates reporting tools.
  • Acts as liaison between Enrollment and other Customer Service staff.
  • Conducts quality assurance audits.
• 5% - Other
  • Completes other projects and duties as assigned to ensure operations and department business needs are successful.
    
    

Minimum Qualifications:

• High School diploma or equivalent required PLUS 1 year of experience in eligibility and/or reconciliation required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
  
  

Preferred Qualifications:

• Health insurance background (Medicare), as well as previous experience interacting with regulatory agencies, including the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC).
  Experience with practices related to Medicare.
  Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
  
  

Knowledge & Abilities:

• 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: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
  
  

Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds