Enrollment Representative Lead

RESPONSIBILITIES AND DUTIES:

ESSENTIAL JOB FUNCTIONS:

Functional Category:  Subject Matter Expert

Estimated Percent of time Spent – 10%

• Collaborates with Enrollment Representatives to offer guidance, solve complex problems, make informed decisions and ensure the accuracy and quality of work within the Intake process.
• Provides facts and details that correctly direct other Enrollment Representatives so that potential participant inquiries are handled effectively and efficiently.
• Meets standards for policies, procedures, and best practices to ensure smooth enrollment process and provides Enrollment Representatives with support throughout the process.
• Assists with post enrollment follow up as needed when Enrollment Representatives need expert guidance.
• At the request of the Intake & Enrollment Manager, may contribute data in performance appraisals of Enrollment Representative(s).

Functional Category:  Potential Participant Inquiry

Estimated Percent of time Spent – 35%

• Receives communication from Intake Liaison, community referral, and/or Business Development Specialist to handoff qualified referrals.
• Confirms intake appointment schedule and arrives to appointments on time.
• Completes intake profile with all requested information directly into the Customer Relationship Management (CRM) tool. Profile completed with information obtained from prospective participant or their representative and referral sources when applicable. Gathers information regarding individual situation and service needs.
• Promotes the program to the prospective participant, family members and/or their representatives, aligning messaging with the individual needs of the customer.
• Moves the sale forward during every prospect interaction.
• Provides exceptional customer service to individuals who inquire about, enroll in, and/or participate at RM PACE referral sources. Integrates as a trusted resource who is able to meet the needs of referral sources and prospective participants, encouraging more referrals to be submitted to RM PACE.
• Positively represent RM PACE through professional and collaborative interactions with referral sources.
• Based on comprehensive knowledge of all RM PACE services within the continuum of care, identifies most appropriate services for each potential participant based on their individual situation and needs.
• Schedules center visits, home visits, tours and other interactions with affiliate staff to familiarize potential participants with RM PACE programs and services.
• Utilizes excellent customer service and effective sales techniques to increase service as appropriate for each individual. Strategically identifies and generates additional referrals through referral source and prospective participant interactions.

Functional Category:  Enrollment Process Management

Estimated Percent of time Spent – 45%

• Real time accurate updates of prospect progress into EHR and/or CRM system.
• Works closely with applicant and/or applicant’s representatives as primary point of contact throughout enrollment process. 
• Coordinates with applicant and/or applicant’s representatives to collect necessary information and documentation throughout the approval and Medicaid enrollment process. 
• Completes scheduling and documentation for enrollment, assessment, Medicaid, and level of care as appropriate.
• Maintains accurate documentation and actively monitors the application process for each potential participant/client throughout the enrollment process to ensure participant/client is enrolled. Provides accurate and timely documentation throughout the enrollment process and shares information with other team members as needed to complete the enrollment process.
• Presents prospect cases to their enrollment decision team to advocate for the prospects and make the internal sale to the team by presenting accurate and pertinent information regarding the prospect’s living situation, condition and service needs.
• Closely collaborate with the Eligibility Advocate and related third parties to properly complete, submit and monitor Medicaid application process to help individuals access Medicaid benefits in order to enroll in RM PACE.
• Understands, possesses and utilizes sales skills to “close” the transaction.
• Performs home visits and/or day center visits to complete all Medicaid enrollments within required timeframes.

Functional Category:  Post Enrollment Follow up/Additional Duties

Estimated Percent of time Spent – 10%

• To ensure prospect’s smooth transition into the program, works closely with the interdisciplinary team, marketing/sales, operations, Medicaid, accounting, and others.  
• Provides hand-off of cases when appropriate to key staff post-enrollment.
• Working collaboratively with other team members, responsible for attaining established census goals.
• Works closely with affiliate staff and RM PACE marketing/sales to increase community awareness of and strengthen positive brand image of RM PACE.
• Consistently cooperates and supports the organization in identifying and solving problems/issues.
• Ensures customer satisfaction by understanding and applying the Quality and Compliance Procedures and Standards.
• Participates in any required staff meetings and trainings.
• Performs other duties as requested in a positive and helpful manner to ensure a smooth-running work area.

Travel Required:

• Local travel required

KEY PERFORMANCE INDICATORS

• Conducts a minimum of 26 home visits monthly
• Enroll a minimum of 10 participants monthly into the PACE program

QUALIFICATIONS AND REQUIREMENTS:

• Bachelor’s degree in business, sales, marketing, social work or a related field from an accredited college/university or applicable experience in lieu of educational requirements.
• Requires personal transportation, valid state issued driver’s license, good driving record and auto insurance as required by law.
• Two (2) years of proven successful healthcare focused sales and marketing in both B2B (hospitals, healthcare providers, senior living communities, etc.) referral sources and B2C (individual patient) settings, Medicare Advantage plans, Managed Care Medicaid plans, Veterans Administration health benefits, or equivalent combination of education and experience.
• Experience working with elderly and/or disabled populations preferred.
• Experience working with an Electronic Health Record preferred.
• Must have experience in comparable healthcare, insurance, or related industry and be able to “close” the sale.
• Proven track record of meeting or exceeding sales goals.
• Extensive knowledge of community resources available to seniors and their families.
• Ability to effectively represent the program to participants, families, outside agencies, community groups, community professionals and the general public.
• Ability to work independently and exercise sound judgment.
• Must have excellent written and verbal communication skills and demonstrate the ability to interact clearly and effectively with both internal and external customers.
• Strong administrative support skills and proficiency with MS Office suite software including Excel.
• Skilled in establishing and maintaining effective working relationships with participants, co-workers, vendors, medical staff, and the public.