Referral and Enrollment Specialist

New York, Full-Time
  • Acts as the gatekeeper for any referrals sent to CCF by interfacing with families, Managed Care Organizations (MCOs), Hospital Partners, and other referral sources
  • Enters new outside referrals into the Medicaid Analytics Performance Portal (MAPP)
  • Communicates with CMAs regarding capacity and ability to work with potential new members
  • Retrieves and formats data and generates reports as needed in GSIHealth and MAPP
  • Distributes gaps in care, GSI errors, and referral information to CMAs as needed
  • Works with hospital partners and providers to establish smooth and efficient referral workflows
  • Goes to hospital clinics to screen patients for eligibility and enroll if appropriate
  • Answers members, partners, and community based administrative and provider inquiries based on HIPAA and DOH regulations
  • Attends meetings as assigned, and follows up after meetings to ensure assignments, projects, and other tasks are progressing in a timely manner
  • Reviews, processes, inputs, and follows up with member referrals from a variety of sources in compliance with established referral guidelines and procedures
  • Troubleshoots any errors that occur in MAPP with regards to new or current referrals made to CCF
  • Communicates with CMAs and MCOs and other providers on all referral related matters
  • Provides administrative support in the preparation of presentations
  • Follows up with Care Management Agencies on outstanding issues within guidelines set by CCF

·        Recommends systems of efficiency and identifies any issues with the enrollment workflow process

·        Responds to all correspondence in a timely manner and directs questions, concerns and request to the appropriate CCF employee when necessary as needed

·        Maintains working knowledge of NYS DOH policies and external events relating to CCF

·        Follows up and resolves administrative issues in a timely manner

·        Performs special projects and related duties as required

·        Other related task that may be assigned.

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