Description

Department : Enrollment and Eligibility

Position : Certified Application Counselor

Employee Category : Non-Exempt

Reporting Relationship : Vice President of Patient Engagement & Projects

Character Qualities

• Patience - Accepting a difficult situation without giving a deadline to remove it.
• Availability - Making my schedule and priorities secondary to the wishes of those I serve.
• Enthusiasm - Expressing joy in each task as I give my best effort.
• Flexibility - Willingness to change plans or ideas without getting upset.
• Responsibility - Knowing and doing what is expected of me.
  
  

Summary Of Duties And Responsibilities

The Certified Application Counselor (CAC) assists clients with online application and enrollment for SoonerCare, Soon To Be Sooners, and with the health insurance options available through the Affordable Care Act (ACA) Marketplace (also called Exchange). Provides education to individual clients about health insurance and SoonerCare. Promotes awareness of the availability of health insurance through outreach and in-reach activities such as working with the Variety Care Billing Department and providing information to WIC classes.

Responsibilities

Primary Duties and Responsibilities :

• Demonstrates and maintains expertise in the eligibility and enrollment rules and procedures of the Health Insurance Marketplace and SoonerCare (Oklahoma Health Care Authority).
• Provides information and enrollment assistance to clients/patients in a fair, accurate, and impartial manner that is culturally and linguistically appropriate.
• Determines which coverage clients are eligible to apply for: Medicaid or ACA Exchange.
• Enrolls eligible clients in SoonerCare, Soon To Be Sooners, or any other available Medicaid program following OHCA rules and using Agency View.
• Assists clients/patients with setting up Marketplace accounts and navigating through the process of applying for a subsidy and selecting health insurance.
• Educates eligible clients/patients about terminology and responsibilities that may be unfamiliar to previously uninsured patients, including monthly premium obligations, co-pays, coverage options, as well as the new provisions for subsidies and individual tax credits intended to make the purchase of health insurance more affordable.
• Assists clients with making their own informed selection from the Marketplace health coverage options – never recommend which plan or option to select.
• Follows up with clients/patients as needed to assist with completion of enrollment.
• Assists clients/patients with Marketplace exemptions and appeals.
• Identifies internal enrollment barriers and coordinate with Variety Care staff to resolve issues.
• Identifies external barriers and share with the Variety Care enrollment team for discussion.
• When appropriate, informs clients about the range of medical, dental, behavioral health, WIC, and support services available at Variety Care and facilitate an appointment.
• Performs public education and outreach activities to raise awareness about Medicaid, Marketplace, and the enrollment assistance available at Variety Care.
• Makes referrals to Variety Care and external social services resources as appropriate.
• Performs internal ECW and other documentation and reporting responsibilities as assigned.
• Supports Variety Care’s Patient Centered Medical Home approach and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient and Equitable. Collaborate to achieve the “Triple Aim” of healthcare reform goals – improve the experience of care for our patients, improve health outcomes, decrease healthcare costs.
• Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment. Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable.
• Performs other duties as assigned.
  
  

Qualifications

Requirements, Special Skills or Knowledge :

• High school diploma or GED.
• Must complete CAC training and receive certification.
• Register with the Oklahoma Insurance Department as Navigator.
• Experience using a computer.
• Basic communication skills.
• Experience handling confidential information.
• Must have valid driver’s license and reliable transportation.
• Bilingual (English/Spanish).
  
  

Preferred Requirements

Preferred Requirements, Special Skills or Knowledge :

• Post-secondary education.
• Experience in community outreach work.
• Experience with SoonerCare Agency View.
  
  

Essential Functions

• Able to lift a minimum of 25 pounds.
• Able to drive to Variety Care sites and outreach locations.