INTAKE NAVIGATOR at C2Q Health Solutions

JOB PURPOSE

The Data Entry & Eligibility Specialist will directly educate a referral source and /or prospective participant through the onboarding process leading to enrollment in CenterLight’s Program of All-inclusive Care for the Elderly (PACE). This position will work closely with the Business Development and Intake teams to ensure all referrals are processed in a timely manner and all data is entered completely and accurately in the system. The Data Entry & Eligibility Specialist is expected to maintain ethical conduct, compliance with state, federal and PACE regulatory requirements, and will be responsible for quality and satisfaction of prospective participants, caregivers, and referral sources.

JOB RESPONSIBILITIES

• Monitor the referrals email and eFax inboxes to ensure all referrals are acknowledged, reviewed/responded to, and logged in the organization’s database in a timely manner.
• Assign referrals received via email, fax, phone or in person to an Account Manager and/or Intake Navigator for immediate follow-up.
• Review each referral and ensure all information needed to proceed to the next step of enrollment is complete.
• If referral information is incomplete, directly, and immediately contact referral source, provider, prospective participant, and any other audiences to gather any missing information.
• Assist with obtaining referral details to help assess and determine appropriate next steps for expeditious enrollment processing.
• Enter calls, inquiries, and prospective participant information into the central database upon receipt of the referral, and ensure all data entered is accurate and complete.
• Upload all paperwork required for each referral into the central database, including referral forms, entitlement applications, CDPAS forms and other necessary documentation.
• Assist with completion and follow-up of enrollment and other required forms using the organization’s digital platform as needed.
• Follow up with referral source, provider, prospective participant, and other audiences to gather any missing paperwork.
• Work closely with the Business Development, Intake and Enrollment departments to ensure timely responses to all inquiries and referrals.
• Send weekly reports to the referral sources on the status of their referrals.
• Meet the departmental productivity goals as specified by management for the growth of the company.
• Become an expert about CenterLight PACE program eligibility requirements, services, and benefits.
• Perform provider network verification and other validation of provider participation as needed.
• Maintain and generate reports to measure performance and quality of work as set forth by CenterLight.

Adhere to all HIPAA standards and confidentiality requirements.

• Participate in implementing workflows and Standard Operating Procedures.
• Advise on the development of tools and process improvements to increase quality and departmental operational efficiencies.
• Maintain knowledge of all applicable CMS, DOH and PACE-specific guidelines, including organizational and departmental policies and procedures.
• Maintain compliance with Medicaid, Medicare, and PACE regulations.
All other duties as assigned or requested

Weekly Hours: 40

Schedule: 8:30AM – 5:30 PM

QUALIFICATIONS

Education: High School Diploma required, Associate Degree preferred.

Experience

Minimum 2 years work experience in healthcare; preferably with MLTC, MAP, or PACE programs and/or homecare; primarily in intake/enrollment functions.

Knowledge of Medicaid, Medicare and PACE regulations for eligibility and enrollment.

Proficiency with CRM platforms; knowledge of Care Compass strongly preferred.

Knowledge of Maximus, eMedNY, ePACES, CMS MARx and other related HRA/CMS resources and functions, preferred.

Proficiency in Microsoft Excel, Word. Outlook and Teams.

Excellent interpersonal skills, along with demonstrated ability to handle situations requiring immediate and urgent attention, while meeting targets and projections and performing daily tasks.

Highly organized and flexible to meet submission deadlines.

Experience in working independently without significant oversight and or direction from a supervisor.

Comprehensive understanding of federal and state regulatory requirements with respect to health care eligibility, coverage and services of various public programs a plus.

Familiarity with healthcare organizations and general population dynamics within the greater New York Metropolitan region a plus.

Other

• Positive attitude and outlook with the ability to multi-task in a constantly changing environment.
• Team-oriented with the ability to gain cooperation through relationship building and positive persuasion.

Written and verbal fluency in a secondary language a plus.

Physical Requirements

Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to:

• Standing – Duration of up to 6 hours a day.
• Sitting/Stationary positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods.
• Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc.
• Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job.
• Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas.
• Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.)
• Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy.
• Audio Hearing and Motor Skills (language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual.
• Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Disclaimer: Responsibilities and tasks outlined in this job description are not exhaustive and may change as determined by the needs of the company.

We are an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, height, weight, or genetic information. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities.

Salary Range (Min-Max)

$61,000.00 - $71,000.00