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ECM Enrollment Specialist

3 hours, 55 minutes ago
United States
Full-time
Mid Level
Customer Support
Customer and Technical Support
HIPAA
Apply Now
Pacific Health Group

Pacific Health Group

Pacific Health Group Your Life's Partner through the Journey of Wellness Your Healthcare Concierge Housing and Community Services Family, Individual & Couples Therapy Transportation services at your finger tips Your Healthcare Concierge Housing and Com...

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Description

  • Assist members with Medi-Cal applications, renewals, redeterminations, and required documentation through BenefitsCal and other channels.
  • Track pending applications, eligibility determinations, deadlines, notices, and member follow-up actions through resolution.
  • Help members address denials, discontinuances, requests for information, reconsiderations, and appeals.
  • Support Medi-Cal Managed Care Plan selection, assignment, enrollment, and activation verification.
  • Maintain a pipeline of prospective members and coordinate handoffs to Member Engagement, ECM, Community Supports, and care management teams.
  • Communicate application status, requirements, barriers, and next steps in clear, member-friendly language.
  • Maintain accurate, timely, HIPAA-compliant case notes, records, outreach attempts, and enrollment tracking.
  • Provide leadership with reporting on pending cases, approvals, denials, delays, MCP assignments, and completed enrollments.
  • Escalate complex eligibility concerns and urgent member needs to appropriate leaders, agencies, or resources.
  • Work independently to move cases forward and ensure eligible members transition into PHG services without unnecessary delays.

Requirements

  • Bilingual Spanish/English proficiency.
  • High school diploma or equivalent.
  • Experience in healthcare administration, insurance enrollment, eligibility, social services, patient navigation, member services, or a related field.
  • Strong computer, data-entry, case-tracking, and documentation skills.
  • Excellent telephone communication and customer service abilities.
  • Strong organization, attention to detail, persistence, problem-solving, and follow-through across multiple cases.
  • Ability to maintain confidentiality and comply with HIPAA and organizational requirements.
  • Ability to work independently in a remote environment and recognize when escalation is needed.
  • Experience with Medi-Cal eligibility and enrollment, BenefitsCal, applications, renewals, appeals, or eligibility troubleshooting preferred.
  • Knowledge of California Medi-Cal Managed Care Plans or experience with CalAIM, ECM, Community Supports, managed care, or community health programs preferred.

Benefits

  • $22.00–$24.00 per hour, depending on experience and qualifications.
  • Remote work for California residents.
  • Monday–Friday schedule, 8:00 AM–4:30 PM.
  • 401(k) matching.
  • Medical, dental, and vision insurance.
  • Life insurance.
  • Paid time off.

Interested in this position?

Apply directly on the company website

Apply Now

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