Enrollment Specialist

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🏄 California – Remote

🏄 California – Remote

💵 $21 - $24 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

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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 applicable enrollment channels • Guide members through documentation, verification requirements, renewals, redeterminations, and next steps • Monitor pending applications and eligibility status through BenefitsCal and approved systems • Follow up with members, counties, health plans, and other entities to resolve outstanding applications and eligibility issues • Help members address denials, discontinuances, requests for information, reconsideration requests, and appeals • Assist members with Medi-Cal Managed Care Plan options, enrollment, assignment, and activation verification • Maintain a pipeline of prospective members through application, eligibility, MCP enrollment, authorization, and program readiness stages • Coordinate handoffs with Member Engagement, Street Outreach, ECM, Community Supports, Lead Care Managers, and other departments • Maintain regular member contact and explain complex insurance and eligibility processes clearly • Track deadlines, notices, renewal dates, required actions, outreach attempts, and case status • Maintain accurate, complete, HIPAA-compliant, audit-ready documentation • Report pending cases, delays, denials, approvals, MCP assignments, and completed enrollments to leadership • Escalate urgent needs and complex eligibility issues according to PHG protocols

🎯 Requirements

• 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 many 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 • Preferred: experience with Medi-Cal eligibility and enrollment • Preferred: experience using BenefitsCal • Preferred: knowledge of California Medi-Cal Managed Care Plans • Preferred: experience assisting with Medi-Cal applications, renewals, appeals, or eligibility troubleshooting • Preferred: experience with underserved, justice-involved, unhoused, or medically complex populations • Preferred: experience within CalAIM, Enhanced Care Management, Community Supports, managed care, or community health programs • Bilingual skills strongly preferred • Ability to work independently in a remote environment • Ability to recognize when an issue requires escalation • Comfort communicating with counties, health plans, providers, and internal departments • Must maintain a private, HIPAA-compliant remote workspace • Requires prolonged periods of computer and telephone use

🏖️ Benefits

• 401(k) matching • Dental insurance • Health insurance • Life insurance • Paid time off • Vision insurance • Remote work arrangement • Occasional travel for trainings, meetings, or organizational needs