Job Details

Join our award winning culture as we support members within the state of Wisconsin!

Position Summary:

Under the general supervision of the Enrollment Manager, the Member Enrollment Specialist is responsible for enrollment and eligibility coordination of Lakeland Care, Inc. (LCI) membership. The Member Enrollment Specialist ensures that member enrollment information is accurately maintained in the Wisconsin Forward Health system, CARES system, and Lakeland Care system. The Member Enrollment Specialist monitors the eligibility status of members in an assigned caseload and assists members as needed in fulfilling annual financial reporting requirements for Medicaid membership recertification.

Essential Competencies:

Accountability

• Oversee the data entry of member demographic and enrollment information into the TruCare System as well as any state systems; handle daily decisions and problem solving.
• Oversee members due for their MA renewal and monitor progress in completing the renewal timely to maintain financial eligibility.
• Review and monitor pending and final enrollments and determine discrepancies with local systems;
• Participate in monthly reconciliation of enrollment and capitation data from the LCI database in comparison to the Forward Health system and initiate and monitor corrections to safeguard member eligibility for Family Care programs.
• Responsible for monitoring past due member balances and setting up payment plans for members when appropriate.

Critical Thinking

• Evaluate member fulfillment of eligibility requirements and identify level of risk in continuing service to members with incomplete eligibility documentation. Refer members with high-risk eligibility for disenrollment.
• Monitor and evaluate Family Care enrollment trends in the assigned counties and recommendations on how to maintain or increase enrollment in the assigned counties.
• Ability to comprehend complex material and concepts and apply them to varying situations.
• Ability to identify issues or concerns with current processes or issues that arise and provide solution focused recommendations for improvement.

Commitment to Excellence

• Participate in trainings or informational sessions to ensure familiarity with state and federal regulations updates or changes that may impact member obligations or Medicaid eligibility.
• Strive to maintain member eligibility by proactive communication with members who are due for a Medicaid recertification review or are at risk to become ineligible.
• Respond timely to member and staff questions regarding eligibility for Family Care and Medicaid.
• Monitor and report costs associated with membership whose eligibility is at risk.
• Assist in the development of workflows, processes and policies related to member enrollment and eligibility.

Interpersonal Awareness

• Provide exceptional customer service to member's as the main point of contact regarding their eligibility for Family Care or Medicaid.
• Ability to communicate complex concepts to members and families in empathetic yet businesslike manner.
• Respect others' opinions and concerns and value diversity in thought and action.
• Display a positive attitude and actively listen to others.

Relationship Building

• Provide support and education to members and LCI staff related to maintaining eligibility for Family Care and Medicaid.
• Serve as a liaison between LCI and county Income Maintenance staff in order to assist members in understanding and maintaining eligibility for Medical Assistance.
• Work with the local Aging and Disability Resource Centers (ADRCs) to coordinate enrollment and disenrollment dates and member specific Family Care eligibility issues.
• Meet regularly with ADRCs and Income Maintenance agencies to maintain a collaborative approach to member service.

Organizational Regard

• Maintain the confidentiality of client information and protected health information as required by State and Federal regulations, including the Health Insurance Portability and Accountability (HIPAA) Act of 1996.
• Comply with applicable federal and state laws, administrative rules, established organizational procedures and accepted professional standards.

Requirements

• Bachelor's degree in Business Management, other related field, or equivalent combination of education and experience (includes knowledge, skills, and abilities).
• Minimum of two (2) years' experience in Medicaid eligibility.
• Considerable knowledge in automated systems and software including MS Office Suite products and Spreadsheet applications. Experience with the TruCare System or similar product a plus.
• Knowledge of state Medicaid information systems (Forward Health and CARES) beneficial.
• Experience in a health care, human services, and/or non-profit agency setting.
• Exemplary customer service skills.
• Strong written and verbal communication skills.
• Strong time management and organization skills.
• Ability to function effectively in a fast-paced and changing environment with multiple priorities and objectives required.
• Current driver's license, acceptable driving record and proof of adequate insurance required.

Lakeland Care is a Wisconsin-based, top workplace award winning, non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), we provide long-term care services to eligible elders and individuals with physical and intellectual or developmental disabilities. Currently we serve members in 22 counties and have 11 offices throughout the Central to North East region of Wisconsin.

We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. We are an organization that participates in E-Verify.