Job Description

Job Description

Pillar Health, a Division of Kenosha Community Health Center, is hiring for an experienced Medicaid Enrollment Manager. The Medicaid Enrollment Manager is responsible for managing the operational aspects of the organizations outstation Medicaid enrollment program.

This position will lead the coordination for Medicaid eligibility and enrollment activities, ensuring compliance with federal and state regulation, increasing patient coverage rates and improving access to care.

Essential Functions/Key Competencies

• Program Coordination & Enrollment Execution: Serve as the primary point of contact for all outstation enrollment activities.
• Assist patients in completing Medicaid applications, renewals, and eligibility reviews at all clinic locations.
• Verify insurance eligibility and educate patients on coverage options, documentation requirements, and enrollment timelines.
• Coordinate with clinic registration, billing, and care management teams to reduce gaps in coverage and streamline enrollment processes.
• Maintain accurate documentation of patient interactions, eligibility outcomes, and application status in the EHR and required databases.

Compliance & Regulatory Oversight

• Ensure adherence to state Medicaid outstation regulations, organizations compliance standards, and HRSA requirements.
• Serve as liaison to state Medicaid agencies, Managed Care Organizations, and advocacy organizations.
• Maintain up-to-date knowledge of Medicaid policies, including expansion programs, redeterminations, presumptive eligibility, and special population criteria.

Data Tracking & Reporting

• Track Program performance metrics such as applications submitted, approvals, denials, and processing times.
• Prepare monthly, quarterly, and annual reports on enrollment outcomes and trends.
• Identify system or workflow barriers and recommend process improvements to enhance efficiency and patient outcomes.

Outreach & Community Engagement

• Conduct outreach events and provide education to patients, families, and community members regarding Medicaid enrollment opportunities.
• Build and sustain partnerships with local schools, shelters, housing authorities, and other community access points.
• Represent the organization at community-based enrollment fairs, coalitions, and health-related forums.

Internal Collaboration & Training

• Act as an internal resource for staff on Medicaid eligibility questions and updates.
• Develop and maintain enrollment SOPs and referral workflows in collaboration with Patient Access staff.
• Coordinate with Quality, Compliance, and Revenue Cycle teams to ensure accurate data collection and reporting alignment.

KEY DELIVERABLES

• Program Coordination & Enrollment Execution: Minimum of 25 Medicaid applications submitted per month, including new applications and renewals.
• 80%+ application approval rate within 60 days of submission.
• Average application completion time (from intake to submission) of less than five business days.
• Achieve a reduction of uninsured patient visits at clinic sites.

Position Requirements

• Associates or Bachelors degree in Health Administration, Public Health, Human Services, or related field preferred.
• Minimum 3 years of direct experience in Medicaid enrollment, patient navigation, or financial advocacy.
• Experience working within an FQHC or other safety net provider highly preferred.
• Working knowledge of Medicaid programs and eligibility criteria in the State of Wisconsin.
• Strong understanding of health coverage options, Medicaid systems, and regulatory requirements.
• Bilingual (English/Spanish) preferred but not required.

Physical/Environmental

• Up to 80% of time spent sitting at a desk or workstation, occasional standing and walking.
• Frequent computer use and handling of documents, requires clear vision, hearing and verbal communication.
• Occasional lifting of materials or outreach supplies up to 25 pounds.
• Up to 25% travel required to clinic locations, community sites and partner locations.
• Low exposure risk to infectious diseases, must follow infection control protocols.

WORK SCHEDULE

Open availability to work up to 40 hours during clinic operating hours. Clinics generally operate Monday Thursday, 7 am 7 pm, Friday, 7 am 5 pm, and Saturday, 7 am 3 pm.

What We Offer

As a full-time employee, you will receive an impressive portfolio of benefits designed to help you maintain a comfortable lifestyle for you and your qualifying dependents, including Major Medical, Dental, Vision, Flexible Spending Account, Short-term Disability, Long-term Disability, Life Insurance, Employee Assistant Program, 403(b), Paid Time Off, including Holidays. Qualifying employer for Public Service Loan Forgiveness (PSLF). Annual salary to commensurate with experience.

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