CHW-Outreach & Enrollment Specialist

The Outreach and Enrollment Specialist (Navigator) plays a key role in educating consumers about health plan options. The position provides educational outreach and enrollment services to all consumers. The O/E Specialist is a trusted source for information that provides no cost, fair, and impartial information to help with financial assistance eligibility and facilitate enrollment in health plans. This position also oversees presumptive eligibility enrollment for Medicaid and oversight of that program and services.

Functional Area: Enrollment | Estimated Effort: 60%

Responsibilities, Deliverables, Outcomes, and Expectations

• Assist uninsured individuals with completing coverage applications, gathering documentation, and navigating the enrollment process for Marketplace, Medicaid, and Medicare.

• Provide follow-up support, tracking, and data collection to assure continuous coverage and full Medicaid benefits when applicable.

• Provide structured patient education on health coverage, engage in follow-up conversations, and offer renewal assistance for enrolled individuals.

• Maintain accurate enrollment records, meet established goals, and submit required reports.

• Set and meet enrollment and patient satisfaction goals.

• Continuously expand knowledge of available health and community resources.

• Remain up to date on Medicare, Medicaid, and Marketplace changes and updates, including Marketplace auto-enrollment notices.

• Maintain confidentiality of patient information in compliance with HIPAA and agency policies.

Functional Area: Outreach | Estimated Effort: 30%

Responsibilities, Deliverables, Outcomes, and Expectations

• Distribute outreach materials to patients, community members, community organizations, and businesses to build coverage option awareness.

• Develop, discover, and attend community events to promote health coverage options and organization services.

• Notify existing uninsured patients about available coverage options and assist them in exploring enrollment opportunities.

• Build and maintain referral networks through collaboration with local agencies, coalitions, and interest groups.

• Assist with the design and implementation of outreach campaigns and enrollment initiatives.

• Conduct presentations or workshops to educate the community about available healthcare services and insurance coverage options.

Functional Area: Service, Training, and Other Responsibilities | Estimated Effort: 10%

Responsibilities, Deliverables, Outcomes, and Expectations

• Identify and assist with the preparation of grant applications to support specific program objectives and targeted outcomes.

• Analyze reports, interpret data, and track program outcomes.

• Attend and successfully complete all required training programs; participate in ongoing conference calls, webinars, and other professional development opportunities.

• Attend meetings, conferences, and training sessions, and disseminate acquired information with staff.

• Serve on CAC committees and perform other agency service duties as assigned.

• Serve as a representative of CAC on assigned outside committees as deemed appropriate.

• Perform other duties as assigned.

Minimum Requirements

Education:

• High School Diploma or equivalent required.

• Bachelor’s Degree in Human Services, Social Work, Business Administration, or Health Sciences preferred.

Job-Related Experience:

• At least 3 years of previous experience in a health care setting involving state and federal health care programs.

• Strong public speaking skills with the ability to engage audiences.

• Knowledge of health insurance programs, public coverage options, and community resources.

• Proven ability to work independently and manage multiple tasks simultaneously.

• Proficiency with Microsoft Office applications.

• Valid driver’s license, reliable transportation, proof of insurance, and insurability under agency insurance.

• Excellent customer service and interpersonal skills.

• Commitment to maintaining confidential information and exercising sound judgment.

Agency Requirements:

• Primary Source Verification of education and training.

• Completion of a query of the Office of Inspector General (OIG).

• Current valid driver’s license, proof of automobile insurance, insurable under the agency insurance policy, and reliable transportation.

Licenses, Certifications, and Accreditations:

• Active Community Health Worker (CHW) Certification or ability to obtain upon hire.

• Ability to gain Navigator Certification and OSHIIP Volunteer Certification.

• Current BLS/CPR Certification or ability to obtain upon hire.

• Certified Application Counselor Certification or ability to obtain upon hire.

Preferred Qualifications

• Experience working with electronic health records, specifically eCW.

• Experience and knowledge regarding insurance, Medicaid, and Medicare requirements and enrollment processes.