Medicare Education & Enrollment Specialist

Title: Medicare Education & Enrollment Specialist

Department: Eligibility & Enrollment

Reports To: Manager of Eligibility & Enrollment

Summary

The Medicare Education & Enrollment Specialist fosters patient access to care by providing neutral, accurate education regarding Medicare coverage options and assisting patients with Medicare and Medicaid enrollment and coordination processes. The Specialist works directly with patients, clients and staff to ensure accurate coverage documentation and to reduce barriers to care related to Medicare, Medicaid, and Sliding Fee Scale (SFS) eligibility.

The Specialist assists patients to understand Medicare coverage options, navigate enrollment timelines and processes, understand dual eligibility and Medicare Savings Programs, complete Medicaid applications when appropriate, and access public benefits that maximize access to care.

The Specialist must maintain strict neutrality regarding plan selection and may not recommend or endorse any specific insurance plan.

Essential Duties and Responsibilities

Provides neutral education regarding Medicare coverage options including Traditional Medicare, Medicare Advantage, Medicare Part D and supplemental coverage

Assists patients with Medicare Part A and Part B enrollment processes

Assists patients with Medicaid enrollment applications and renewal processes

Supports Sliding Fee Scale (SFS) application completion and documentation requirements

Maintains certification as an Application Counselor, as required, and complies with all related regulatory standards

Educates patients on enrollment periods, coverage transitions and potential late enrollment penalties

Refers patients to independent resources for plan comparison and selection assistance

Assists patients in understanding dual eligibility and Medicare/Medicaid coordination of benefits

Supports applications for Medicare Savings Programs and Low-Income Subsidy

Collaborates with internal staff to ensure accurate insurance documentation in Epic

Works with billing and revenue cycle teams to verify Medicare and Medicaid eligibility and prevent coverage gaps

Interacts with Social Security Administration, Department of Social Services and community partners as needed

Tracks enrollment assistance activities and prepares periodic reports

Participates in patient education efforts and outreach events

Qualifications

Education: Associate's or Bachelor's Degree preferred in healthcare administration, public health or related field.

Experience: Minimum of three (3) years experience in health insurance eligibility, enrollment or patient financial services.

Knowledge/Abilities: Familiarity with Medicare and Medicaid programs, HIPAA compliance, Epic preferred, strong organizational and communication skills.

Knowledge/Abilities: Familiarity with Medicare and Medicaid programs,. Bilingual (English and Spanish) required. Excellent communication, verbal and written skills and ability to compile and analyze data with competency in Microsoft Word, Excel, Outlook and Power Point. Must be familiar with HIPAA and other privacy related laws and sensitive to patients/clients' confidentiality needs. Must be sensitive to patients/clients' cultural values. Must be able to work with minimum of direct supervision, show initiative and be proactive in problem-solving.

CS-HHC is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.