CERTIFIED ENROLLMENT COUNSELOR

Opsam Health

At Opsam Health, we deliver patient-focused care. We are a federally qualified healthcare facility that was established in 1973. We remain steadfast in our mission to provide high-quality, patient-centered care to every individual and family we serve. We welcome everyone to our clinics. Whether you have the ability to pay or not, whether you are homeless or a migrant, or whether you are insured or uninsured, you will be treated with the utmost respect and compassion. We proudly serve communities throughout San Diego County from South Bay to North County. In addition to our comprehensive healthcare services, patients have access to a wide range of resources. These include adult primary care, pediatric care, women’s health, dental services, mental health services, chiropractic care, specialty care, insurance enrollment assistance, transportation assistance, and care management.

As a key member of our FQHC team, the Insurance Enrollment Counselor independently guides individuals and families through the enrollment and re-enrollment processes for state-sponsored health insurance programs such as Medi-Cal, Covered California, and related initiatives. This role is responsible for accurately assessing eligibility, assisting with necessary documentation, and empowering clients to make informed decisions about their health coverage. In addition to managing the enrollment process, the Counselor provides essential case management by conducting client intakes, coordinating care with healthcare providers, and connecting clients with community resources. By ensuring uninterrupted access to healthcare services and promoting health equity, the Enrollment Counselor plays a vital role in advancing the overall mission of our center.

Insurance Enrolment

• Guide individuals and families through the enrollment and re-enrollment process for state-sponsored health insurance programs including Medi-Cal, Covered California, and other initiatives.
• Review income, household size, and other eligibility factors to determine client qualification for various health plans.
• Assist clients in gathering and submitting required documentation, such as proof of income, residency, and identification.
• Educate clients on plan options, benefits, and health insurance terminology to facilitate informed decision-making.
• Support clients in completing online applications and all necessary enrollment forms accurately.

Case Management

• Conduct comprehensive intake interviews to assess clients’ health needs, eligibility, and any existing barriers to accessing care.
• Coordinate care by linking clients with appropriate clinic providers and scheduling necessary appointments.
• Monitor clients’ enrollment status with regular follow-ups to ensure continued access to healthcare services and address any issues that arise.
• Advocate for clients by assisting with the resolution of issues related to insurance coverage or healthcare access.
• Connect clients with additional community resources such as food assistance, housing support, mental health services, or legal aid when needed.
• Maintain accurate and up-to-date case records in compliance with confidentiality and regulatory guidelines.

Reporting

• Stay informed of changes in California healthcare laws, eligibility guidelines, and available insurance plans to provide accurate assistance.
• Ensure that all enrollment and case management activities comply with FQHC policies and relevant state and federal regulations.
• Prepare and submit regular reports on enrollment statistics, client outcomes, and any challenges encountered during case management.
• Participate in ongoing training and professional development to keep current with new programs, regulations, and system updates.

• Maintain professional working relationships with all levels of staff, clients and the public.
• Be a team player and cooperate in accomplishing department goals and objectives.

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  Maintain confidentiality of all patient, employee, and volunteer information. Access data only on a need-to-know basis.
• Adhere to HIPAA and all applicable state and federal privacy regulations.
• Handle sensitive information with discretion and secure data practices.
• Report any unethical, fraudulent, or unlawful behavior, including breaches of confidentiality.

• Strong knowledge of Medi-Cal, Covered California, and other insurance options. Familiarity with healthcare systems, eligibility guidelines, and benefits is essential
• Bachelor’s degree in Social Work, Health Administration, Public Health, or a related field. (Some positions may require additional certifications or licenses.)
• At least 1–2 years of experience in healthcare insurance enrollment, case management, or a similar role. FQHC Experience is a plus.
• Certification as a Certified Enrollment Counselor (CEC) or similar designation is a plus.
• Bilingual, Fluency in Tagalog is highly desirable.
• Experience in Community Health: Prior experience working with underserved populations or in community health settings is preferred.

• Have reliable transportation, a clean driving record, and car insurance as required by the state.

• Ability to sit for extended periods while working on a computer.
• Occasional travel within the local area to meet with clients or attend outreach events (depending on the position).
• Occasional lifting of materials (e.g., files, brochures) up to 15 lbs.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time, with or without notice.

SALARY

$21.00 - $26.00 Based on Experience