ECM Enrollment Specialist

🕒 August 13

🏄 California – Remote

🏄 California – Remote

💵 $22 - $24 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 29%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Pacific Health Group

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2023

🏥 Healthcare

🧘 Wellness

🌍 Social Impact

Healthcare • Wellness • Social Impact

Pacific Health Group is a community-focused healthcare organization that delivers integrated medical, behavioral health, and social support services to improve the wellbeing of underserved populations. The organization provides enhanced care management for complex needs, behavioral health and substance-use treatment, community health worker outreach, street medicine for people experiencing homelessness, community support services (including housing assistance), and non-ambulatory medical transportation. Pacific Health Group partners with health plans and centers care on whole-person wellness, equity, and access across multiple locations.

📋 Description

• Assist uninsured prospective members with completing and submitting Medi-Cal applications through BenefitsCal or other enrollment channels • Guide members through application processes, documentation requirements, verification requirements, and next steps • Assist with Medi-Cal renewals and redeterminations • Help gather and submit eligibility documentation • Review applications for completeness and accuracy • Monitor application and eligibility status through BenefitsCal and approved systems • Follow up with members, counties, health plans, and other entities regarding applications and eligibility issues • Identify and resolve missing documentation and barriers to eligibility • Track deadlines, notices, renewal dates, and required member actions • Assist with denials, discontinuances, reconsideration requests, appeals, and requested documentation • Track appeal and reconsideration status through resolution • Escalate complex eligibility issues to leadership or appropriate county/agency • Help members navigate Medi-Cal Managed Care Plan options and enrollment processes • Track MCP assignment and verify active enrollment • Coordinate with internal teams when coverage and MCP status permit PHG enrollment • Maintain a pipeline of prospective members through Medi-Cal application, approval, eligibility resolution, appeals, MCP assignment, authorization, and program handoff stages • Verify coverage and enrollment before transitioning members into active services • Coordinate member handoffs with Member Engagement, Street Outreach, ECM, Community Supports, and other departments • Maintain regular member contact and explain insurance and eligibility processes clearly • Provide application updates and next steps • Identify urgent needs and escalate or connect members with appropriate resources • Maintain accurate, timely, HIPAA-compliant, audit-ready documentation • Track pending cases, unsuccessful outreach attempts, and follow-ups • Provide leadership with regular reporting on pending cases, delays, denials, approvals, MCP assignments, and completed enrollments

🎯 Requirements

• Must be bilingual in Spanish/English • High school diploma or equivalent • Experience in healthcare administration, insurance enrollment, eligibility, social services, patient navigation, member services, or a related field • Strong computer and data-entry skills • Excellent telephone communication and customer service skills • Strong attention to detail and ability to manage a large number of cases simultaneously • Ability to independently follow cases through multiple administrative steps until resolution • Ability to communicate effectively with individuals experiencing complex social and economic barriers • Ability to maintain confidentiality and comply with HIPAA and organizational requirements • Ability to work independently in a remote environment • Must maintain a private, HIPAA-compliant remote workspace • Prolonged periods of computer and telephone use • Occasional travel for trainings, meetings, or organizational needs may be required

🏖️ Benefits

• 401(k) matching • Dental insurance • Health insurance • Life insurance • Paid time off • Vision insurance