APLA Health’s mission is to achieve health care equity and promote well-being for the LGBT and other underserved communities and people living with and affected by HIV. We are a nonprofit, federally qualified health center serving more than 14,000 people annually. We provide 20 different services from 15 locations throughout Los Angeles County, including: medical, dental, and behavioral health care; PrEP counseling and management; health education and HIV prevention; and STD screening and treatment. For people living with HIV, we offer housing support; benefits counseling; home health care; and the Vance North Necessities of Life Program food pantries; among several other critically needed services. Additionally, we are leaders in advocating for policy and legislation that positively impacts the LGBT and HIV communities, provide capacity-building assistance to health departments across the country, and conduct community-based research on issues affecting the communities we serve. For more information, please visit us at aplahealth.org.
APLA Health is currently seeking an Enrollment and Eligibility Supervisor to join our team! We offer great benefits, competitive pay, and great working environment!
• Medical Insurance
• Dental Insurance (no cost for employee)
• Vision Insurance (no cost for employee)
• Long Term Disability
• Group Term Life and AD&D Insurance
• Employee Assistance Program
• Flexible Spending Accounts
• 10 Paid Holidays
• 3 Personal Days
• 10 Vacation Days
• 12 Sick Days
• Metro reimbursement or free parking
• Employer Matched 403b Retirement Plan
This is a great opportunity to make a difference!
Enrollment and Eligibility Supervisor (90016)
The Enrollment & Eligibility Supervisor will oversee the day-to-day operations and team progress in the enrollment department. The Manager will be the APLA Health expert on third-party reimbursement, including Medi-Cal, Medicare, private insurance, ADAP, PrEP-AP, and My Health LA. The Manager will act as support for both team members and management, with the ability to motivate a team, identify opportunities for improvement, develop and build rapport with internal and external customers, colleagues and team. Must have the ability to create and analyze workflows for efficiency and quality, as well as understand data, trends and communicate outcomes.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
• Provides supervisory duties to Enrollment Specialists including, but not limited to:
o Hiring of program staff
o Training of new program staff
o Conducting employee evaluations
o Dispensing disciplinary action up to and including the termination of program staff
o Approval of time off/vacation requests
o Developing training plans
o Developing yearly program objectives/goals
o Developing and monitoring program budgets.
o Setting yearly goals and objectives
• Train enrollment and front office staff on eligibility and enrollment processes as well as data recording requirements in the electronic health record; provide at least annual updates/refresher training for staff.
• Serve as the expert resource for front office and enrollment specialists and other clinic staff on all questions related to third-party payers including patient eligibility and enrollment and benefits translation.
• Perform regular chart audits to ensure staff are correctly entering insurance/health plan and benefits information in the patient’s record including demographic data, scanning appropriate insurance documents, income information and sliding fee applications, eligibility verification, etc.
• Review and improve system for eligibility verification, review of insurance information, and communication of updates and changes.
• Coordinate with Clinic Managers regarding front office staff process improvement opportunities and development of trainings as needed.
• Maintain provider accounts for all health plans and establish user accounts for staff when needed.
• Disseminate to enrollment and front office staff any changes/updates received regarding third-party payers.
• Coordinate with Revenue Cycle staff to maintain accurate patient records and minimize claims denials.
• Identifies key performance indicators and utilizes them to track and manage staff performance.
• Complies with all APLA health policies and procedures; complies with all HIPAA rules and requirements.
OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.
Training and Experience:
High school diploma or equivalent required, Associates degree preferred.
Minimum of five years’ experience performing duties related to healthcare enrollment and eligibility at an insurance office, clinic or hospital. A minimum of two years of supervisory experience.
Advanced knowledge of third-party payer plans, including Medi-Cal (both fee-for-service and managed care plans), Medicare, Covered California, private HMO and PPO plans, My Health LA, Ryan White, ADAP/PrEP-AP, drug manufacturer patient assistance programs, sliding fee scale and CalFresh. Strong knowledge of medical terminology highly preferred. Fluency in written and spoken Spanish highly preferred. Microsoft Office programs
Quickly learn eClinicalWorks and PointCare software and become proficient within three (3) months of employment. Demonstrated ability to set priorities for tasks and to work effectively under minimum supervision in spite of interruptions. Ability to provide services in a non-judgmental fashion and work effectively with diverse populations is required as is the ability to maintain records and follow clinical guidelines/protocols. Must be able to work efficiently and complete tasks with a high degree of accuracy; work and solve problems independently; work flexible hours in order to complete tasks and meet client needs. Ability to be flexible in handling unanticipated client needs is required.
WORKING CONDITIONS/PHYSICAL REQUIREMENTS:
This is primarily an office position that requires only occasional bending, reaching, stooping, lifting and moving of office materials weighing 25 pounds or less. The position requires daily use of a personal computer and requires entering, viewing, and revising text and graphics on the computer terminal and on paper.
Must possess a valid California driver’s license; proof of auto liability insurance; and have the use of a personal vehicle for work related purposes.
Equal Opportunity Employer: minority/female/disability/veteran.
Visit our website at www.aplahealth.org to apply or click the link below:
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