Department(s): Customer Service
Reports to: Supervisor, Member Enrollment
FLSA status: Non-Exempt
Salary Grade: C – $41,000 – $53,000
Job Summary
The Program Assistant will provide assistance with specialized services for Medi-Cal eligible members, including data reporting, analysis, and reconciliation. This position is responsible for maintaining eligibility accuracy through daily monitoring, updating and reviewing of the current Medi-Cal program requirements, and must have some specialized background or knowledge relevant to Medi-Cal.
Position Responsibilities:
Coordinates specialized processes that include eligibility analysis, strategic provider assignments, age restriction and complex condition member administration/monitoring and floor audits or the Medi-Cal program.
Responds to questions, interpret policies, and regulations.
Develops materials (e.g., letters/surveys, etc.) and coordinate data files to arrange for mail merge of materials as applicable.
Ensures processes are accurate and compliant with the regulatory requirements by maintaining and documenting process workflows, desktop procedures, and policies and procedures.
Represents the Medi-Cal program on projects or as a liaison within, or outside, CalOptima.
Facilitates communication on specialized topics.
Prepares reports and creates reporting tools; performs special reconciliation procedures, including Excel sorts and mergers, filters and compiling reports, and Access database procedures.
Acts as liaison between the Enrollment department and other Customer Service staff.
Conducts quality assurance audits to validate accuracy of Protected Health Information / Appointment of Representative (PHI/AOR) and Letter of Agreement (LOA) updates processed by other staff members.
Other projects and duties as assigned by management.
Possesses the Ability To:
Provide support to managers and staff within the department.
Coordinate work of specialized processes or functions with staff in the department and other departments within CalOptima, as well as others such as members or providers.
Collect data, identify pertinent information, and prepare reports and presentations.
Conduct presentations and provide information about the CalOptima program in a concise and professional manner.
Interact with other department management / staff in a professional manner.
Communicate clearly and concisely, both verbally and in writing.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Experience & Education:
High school diploma or equivalent required.
1+ year experience of eligibility and/or reconciliation is required.
Preferred Qualification:
Health insurance experience (Medi-Cal) preferred.
Prior experience interacting with regulatory agencies, including Department Health Care Services (DHCS) and Department of Managed Health Care (DMHC) and practices related to Medi-Cal is also preferred.
Experience in a Health Maintenance Organization (HMO), managed care or Medi-Cal setting is preferred.
Bilingual in English and in one of CalOptima’s defined threshold language (Spanish, Vietnamese, Arabic, Farsi, Korean, Chinese) is preferred.
Knowledge of:
Member eligibility, policies, and general responsibilities of the program.
Methods and techniques for organizing and implementing processes.
Basic clerical and/or administrative skills.
Community resources (agencies, services, and leaders of the targeted community).
CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting Human Resources Disability Management at 657-900-1134.
Job Location: Orange, California
Position Type:
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/3337
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