SUMMARY
The State Programs Facilitated Enroller is primarily responsible for assisting individuals with enrollment and renewal applications through the Health Benefits Exchange (NY State of Health) system. This includes reviewing taxes, payroll stubs, and other income documents and reviewing eligibility within Health Benefits Exchange (NY State of Health) and EMEDNY systems according to NYS Department of Health (NYSDOH) guidelines. The State Programs Facilitated Enroller, Level III duties will also include conducting outreach and enrollment calls, working directly with customers at designated off-site locations to assist them with completing their applications, assisting with the NYSOH inquiry process, answering questions regarding specific Staten Island Health Plan (SIHP) plans offered through NYSOH processing member recertification applications, adds, changes and terminations. The Facilitated Enroller will also handle renewals over the phone, and, as needed, customer service events, or additional questions. All candidates must conduct themselves in accordance with regulations and instruction set forth by NYS and the Federal government. In addition, the Facilitated Enroller must have transportation in order to attend off-site appointments and events. Traveling to designated locations will be required, as well as travel to SIHP offices on a regular basis.
ESSENTIAL DUTIES & RESPONSIBILITIES
- Assist members in obtaining and renewing coverage through the NYSOH, including any inquiries in that process, with recertification applications, assisting with changes to their application, and providing general information about the program.
- Travel to designated locations for appointments with prospective or current members and be available for offsite outreach events to promote SIHP corporate mission in assisting member’s needs in the community.
- Point of contact for the resolution of all inquiries received via phone calls, emails or other written correspondence regarding enrollment in the NYSOH. This includes, but is not limited to, making outbound calls to investigate or retrieve missing or incomplete information. Act as principle interface with the customer on the telephone for enrollment and renewals in State Programs. Effectively deliver enrollment verification information via approved scripting, including, but not limited to discussing the use of the plan identification card, provider network, and prescription program, if applicable.
- As directed by the Supervisor, assist members or potential members in signing up for Medicaid, make referrals to the Medicaid Sales team, assist the Medicaid Sales team with enrollments, or assist individual members with their insurance options outside the NYSOH, as appropriate.
- Work with and have a comprehensive understanding of (Facets, EMEDNY, Caremark, Macess EXP, CHPS and NYSOH) database and all other vendor and in-house systems used to perform departmental tasks.
EDUCATION
High school diploma or GED. Associates degree preferred.
Additional requirements:
- Marketplace Facilitated Enroller/Certified Application Counselor certification required, or must be obtained within 30 days of employment.
- NYS Life, Accident and Health license required, or obtained within 60 days of employment.
EXPERIENCE
- Minimum three (3) years of experience in a health insurance setting including health plan, contracting, physician office, or benefits administration required.
- Minimum one (1) year of experience in Government Programs required.
SKILLS & ABILITIES
- Ability to interpret and make decisions based on corporate underwriting guidelines, as well as State of New York & Federal statutes relating to healthcare administration.
- Ability to effectively manage time with multiple task assignments.
- Ability to speak Spanish or another language preferable.
- Must have access to reliable transportation. If driving vehicle for SIHP business, employee must have valid driver’s license, current inspection and appropriate insurance coverage in effect at all times.
- Ability to travel within designated territory and attend after-hours events as needed.
Staten Island Health Plan offers a competitive salary and full benefits.
Please send a resume to Ashley Restaino at arestaino@statenislandpps.org.
