**New employees are mandated to either provide proof of their
COVID vaccination or to receive the vaccine, either through PHC or
their own provider, with the first dose of a series required
before the first day of employment. Exception to this mandate will
be considered for those with a medical or religious exemption.
Summary: The Certified Enrollment Counselor is
responsible for facilitating access to high-quality,
prevention-focused health care by helping individuals and families
enroll in health insurance plans. The Certified Enrollment Counselor
helps individuals and families understand the health insurance options
for which they may be eligible. The Certified Enrollment Counselor is
responsible for helping individuals and families apply for health
insurance programs for which they may be eligible, resulting in
Areas of Responsibility:
Enrollment, In-Reach & Outreach:
· Maximize the number of patients insured in Medi-Cal, Covered
California Plans, CMSP, and other health coverage options.
· Access and address barriers to care, real or perceived, to signing
up for Medi-Cal, CMSP, and other health coverage programs.
· Determine which patients may be eligible for subsidized health
insurance programs and follow up with personal contact
· Enroll consumers into Medi-Cal and/or Covered California health
coverage plans by screening for eligibility, gathering required
documentation, expedites approvals, and assisting with post enrollment
customer service as needed.
· Assist consumers in renewals for Medi-Cal and the exchange.
· Conduct in-reach, outreach and education activities to reach
consumers and their families about Covered California health insurance
options, eligibility, and motivating consumers to enroll in coverage.
· Schedule appointments with applicants, and screen for eligibility
obtaining required information, such as employment information,
income, and other information as needed to complete enrollment.
· Initiate the consumer health coverage application process online.
Assist applicants with the completion of all necessary paperwork and
work to obtain all pending verifications, including enrollment
· Assist consumers through the entire health coverage enrollment
process, including understanding premium assistance and cost sharing,
effectuation of coverage, and maintaining coverage.
· Maintain and report accurate daily/weekly/monthly/quarterly
statistical records to track individual productivity.
· Orient newly covered consumers with their chosen health plan, and
provide them with key contacts to obtain assistance and make premium payments.
· Remain current with community resources and make referrals as
appropriate. Work with county eligibility workers and county offices
to create a positive working relationship.
· Assist applicants in properly completing the applications
· Review and explain the documents that are required with the application
· Ensure the confidentiality of all applications, records, and any
information received in written, oral, or other forms
· Answer phone calls and questions pertaining to the application or
other issues and refer applicants to the proper department or resource agency
· Case management of difficult or urgent cases
· Adhere to State and Federal regulations and policies regarding
marketing and enrollment practices for Covered CA and Medi-Cal Plans.
· Perform other duties as assigned
Qualifications: To perform this job successfully,
an individual must be able to perform each essential duty
satisfactorily. The requirements listed below are representative of
the knowledge, skill, and/or ability required.