Certified Enrollment Counselor

    • Job Tracking ID: 2021-1017
    • Job Location: Petaluma, CA
    • Job Level: Any
    • Level of Education: Any
    • Job Type: Full-Time/Regular
    • Date Updated: January 07, 2022
    • Years of Experience: Any
    • Starting Date: ASAP
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Job Description:

**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 effectuated coverage.

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.

Case Management:

· 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 authorization forms.

· 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.

Experience and Skills:


· Bachelors Degree or Associates Degree preferred

· Certified Enrollment Counselor or Certified Covered California Eligibility Worker Certification required

· Two or more years’ experience assisting clients enroll in health coverage programs

· Experience in working with community organizations and volunteers

Desired Skills:

· Excellent communication skills, both written and verbal

· Experience with sensitivity to the needs of a multi-cultural population from a variety of income levels

· Team player

Language Skills: Bilingual in English and Spanish, both written and verbal preferred.

Mathematical Skills: Ability to add, subtract, multiply, divide in all units of measure, using whole numbers, common fractions and decimals.

Reasoning Ability: Ability to recognize problems, collect data and establish facts.

Computer Skills: Proficient in MS Office (Word, Excel and Outlook), electronic medical records and use of a web browser