Certified Application Counselor

Department: Outreach and Enrollment

Position: Certified Application Counselor

Employee Category: Non-Exempt

Reporting Relationship: Site Specific Practice Administrator

Character Qualities:

Patience- Accepting a difficult situation without giving a deadline to remove it.

Availability- Making my schedule and priorities secondary to the wishes of those I serve.

Enthusiasm- Expressing joy in each task as I give my best effort.

Flexibility- Willingness to change plans or ideas without getting upset.

Responsibility- Knowing and doing what is expected of me.

Summary of Duties and Responsibilities:

Perform the role of Certified Application Counselor (CAC), assisting clients with online application and enrollment for SoonerCare, Soon To Be Sooners, and with the health insurance options available through the Affordable Care Act (ACA) Marketplace (also called Exchange). Provide education to individual clients about health insurance and SoonerCare. Promote awareness of the availability of health insurance through outreach and in-reach activities such as working with the Variety Care Billing Department and providing information to WIC classes.

Primary Duties and Responsibilities:

• Demonstrate and maintain expertise in the eligibility and enrollment rules and procedures of the Health Insurance Marketplace and SoonerCare (Oklahoma Health Care Authority).
• Provide information and enrollment assistance to clients/patients in a fair, accurate and impartial manner that is culturally and linguistically appropriate.
• Determine which coverage clients are eligible to apply for - Medicaid or ACA Exchange.
• Enroll eligible clients in SoonerCare, Soon To Be Sooners, or any other available Medicaid program, following OHCA rules and using Agency View.
• Assist clients/patients with setting up Marketplace accounts and navigating through the process of applying for a subsidy and selecting health insurance.
• Educate eligible clients/patients about terminology and responsibilities that may be unfamiliar to previously uninsured patients, including monthly premium obligations, co-pays, coverage options, as well as the new provisions for subsidies and individual tax credits intended to make the purchase of health insurance more affordable.
• Assist clients with making their own informed selection from the Marketplace health coverage options – never recommend which plan or option to select.
• Follow up with clients/patients as needed to assist with completion of enrollment.
• Assist clients/patients with Marketplace exemptions and appeals.
• Identify internal enrollment barriers and coordinate with Variety Care staff to resolve issues.
• Identify external barriers and share with the Variety Care enrollment team, for discussion.
• When appropriate, inform clients about the range of medical, dental, behavioral health, WIC and support services available at Variety Care and facilitate an appointment if requested.
• Support Variety Care’s Patient Centered Medical Home approach and our commitment to provide care to all Variety patients that is Safe, Effective, Patient Centered, Timely, Efficient and Equitable. Collaborate to achieve the “Triple Aim” of healthcare reform goals – improve the experience of care for our patients, improve health outcomes, decrease healthcare costs.
• Perform public education and outreach activities to raise awareness about Medicaid, the health insurance Marketplace, and the enrollment assistance available at Variety Care.
• Make referrals to Variety Care and external social services resources, as appropriate.
• Perform internal ECW and other documentation and reporting responsibilities, as assigned.
• Other duties, as assigned.

Requirements, Special Skills or Knowledge:

• Successfully complete the required CAC training and receive certification - required.
• Registration with Oklahoma Insurance Department as Navigator – required.
• High school diploma or GED required, post-secondary education preferred.
• Experience in community outreach work preferred.
• Experience with SoonerCare Agency View preferred.
• Bilingual (English/Spanish) preferred.
• Comfortable utilizing a computer to do online training and complete insurance applications.
• Able to communicate complicated information in a manner that assists clients in making decisions about their own and/or their family members health care coverage options.
• Trustworthy in handling confidential information.
• Must have valid driver’s license and reliable transportation.
• Bilingual (English and Spanish) required.

ADA Requirements:

• Able to lift a minimum of 25 pounds.
• Able to drive to Variety Care sites and outreach locations.