What are the responsibilities and job description for the Enrollment Benefits Advisor position at ExcelHealth Group?
Description
The Benefits Advisor serves as a trusted resource for residents and families, providing education and guidance on Medicare, Medicaid, and Managed Care insurance coverage within the long-term care setting. This role focuses on clarifying coverage, identifying gaps, and helping families understand their options, particularly when existing insurance may not fully cover the services needed or may result in out-of-pocket costs. The Benefits Advisor operates with a resident-first, education-based approach, ensuring all conversations are compliant, transparent, and supportive of informed decision-making.
Key Responsibilities
Education & Guidance
Engage with residents and responsible parties via phone and in-person discussions.
Educate families on coverage, deductibles, copays, and out-of-pocket costs.
Explain network limitations and access barriers.
Provide clear explanations of complex insurance topics.
Maintain a non-sales, consultative tone.
Insurance Review & Gap Identification
Analyze Medicare, Medicaid, Managed Care, and private insurance coverage.
Identify coverage gaps impacting access to services.
Explain impact on care, continuity, and financial responsibility.
Program Education & Enrollment Support
Educate on program benefits and access improvements.
Support enrollment with proper consent and accurate documentation.
Reinforce voluntary participation.
Compliance & Documentation
Adhere to HIPAA, CMS guidelines, and internal policies.
Document all interactions and decisions.
Follow cancellation protocols and documentation standards.
Facility & Team Collaboration
Collaborate with SSD, BOM, and nursing staff appropriately.
Collaborate with Billing/Collections/Benefits Verification Specialist
Communicate enrollment activity per workflow.
Performance Expectations
Meet activity and productivity benchmarks.
Ensure application accuracy and proper consent.
Maintain high-quality, resident-centered communication.
Requirements
Required
The Benefits Advisor serves as a trusted resource for residents and families, providing education and guidance on Medicare, Medicaid, and Managed Care insurance coverage within the long-term care setting. This role focuses on clarifying coverage, identifying gaps, and helping families understand their options, particularly when existing insurance may not fully cover the services needed or may result in out-of-pocket costs. The Benefits Advisor operates with a resident-first, education-based approach, ensuring all conversations are compliant, transparent, and supportive of informed decision-making.
Key Responsibilities
Education & Guidance
Engage with residents and responsible parties via phone and in-person discussions.
Educate families on coverage, deductibles, copays, and out-of-pocket costs.
Explain network limitations and access barriers.
Provide clear explanations of complex insurance topics.
Maintain a non-sales, consultative tone.
Insurance Review & Gap Identification
Analyze Medicare, Medicaid, Managed Care, and private insurance coverage.
Identify coverage gaps impacting access to services.
Explain impact on care, continuity, and financial responsibility.
Program Education & Enrollment Support
Educate on program benefits and access improvements.
Support enrollment with proper consent and accurate documentation.
Reinforce voluntary participation.
Compliance & Documentation
Adhere to HIPAA, CMS guidelines, and internal policies.
Document all interactions and decisions.
Follow cancellation protocols and documentation standards.
Facility & Team Collaboration
Collaborate with SSD, BOM, and nursing staff appropriately.
Collaborate with Billing/Collections/Benefits Verification Specialist
Communicate enrollment activity per workflow.
Performance Expectations
Meet activity and productivity benchmarks.
Ensure application accuracy and proper consent.
Maintain high-quality, resident-centered communication.
Requirements
Required
- Active Life/Health Insurance License.
- Strong knowledge of Medicare, Medicaid, and Managed Care.
- Experience explaining insurance to families.
- Ability to simplify complex information.
- Experience in long-term care or healthcare enrollment.
- Familiarity with closed networks and authorizations.
- Experience with CRM/EHR systems.
- Core Competencies
- Family Communication
- Compliance & Integrity
- Critical Thinking
- Professional Presence
- Position Framing