- TEMP POSITION ONLY up to 6 months.
Job SummaryThe Program Assistant will provide assistance with specialized services for Medi-Cal eligible members, including data reporting, analysis, and reconciliation. The incumbent is responsible for maintaining eligibility accuracy through daily monitoring, updating and reviewing of the current Medi-Cal program requirements, and must have some specialized background or knowledge relevant to Medi-Cal.Position Responsibilities
- Coordinates specialized processes that include eligibility analysis, strategic provider assignments, age restriction and complex condition member administration/monitoring and floor audits or the Medi-Cal program.
- Assists with completing various members requests such as Change of Health Network Requests, PCP Change requests, and Data correction forms.
- Responds to questions, interpret policies, and regulations.
- Develops materials (e.g., letters/surveys, etc.) and coordinate data files to arrange for mail merge of materials as applicable.
- Ensures processes are accurate and compliant with the regulatory requirements by maintaining and documenting process workflows, desktop procedures, and policies and procedures.
- Represents the Medi-Cal program on projects or as a liaison.
- Facilitates communication on specialized topics.
- Prepares reports and creates reporting tools; performs special reconciliation procedures, including Excel sorts and mergers, filters and compiling reports, and Access database procedures.
- Acts as liaison between the Enrollment department and other Customer Service staff.
- Conducts quality assurance audits to validate accuracy of Protected Health Information / Appointment of Representative (PHI/AOR) and Letter of Agreement (LOA) updates processed by other staff members.
- Conducts outreaches to members and health insurance carriers to verify potential Other Health Coverage (OHC)
Possesses the Ability To:
- Provide support to managers and staff within the department.
- Interact with other department management/staff in a professional manner.
- Communicate clearly and concisely, both verbally and in writing.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education
- High school diploma or equivalent required.
- 1 year of experience in eligibility and/or reconciliation is required.
Preferred Qualification
- Health insurance experience (Medi-Cal) preferred.
- Prior experience interacting with regulatory agencies, including Department Health Care Services (DHCS) and Department of Managed Health Care (DMHC), and practices related to Medi-Cal is also preferred.
- Experience in a Health Maintenance Organization (HMO), managed care or Medi-Cal setting is preferred.
- Bilingual in English and in Spanish, Vietnamese, Arabic, Farsi, Korean, or Chinese.
- Customer Service experience is preferred.
Knowledge of:
- Member eligibility, policies, and general responsibilities of the program.
- Methods and techniques for organizing and implementing processes.
- Basic clerical and/or administrative skills.
- Community resources (agencies, services, and leaders of the targeted community).
RequirementsBenefitsAt Sunshine Enterprise USA LLC, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:
- Competitive pay & weekly paychecks
- Health, dental, vision, and life insurance
- 401(k) savings plan
- Awards and recognition programs
Sunshine Enterprise USA is an “Equal Opportunity Employer—Minorities, Females, Veterans and Disabled Persons”
