Patient Enrollment Specialist (Chronic Care Management)

The Patient Enrollment Specialist for Chronic Care Management

is responsible for identifying, contacting, screening, and enrolling eligible Medicare patients into the Chronic Care Management program. This role combines patient access functions such as patient registration, demographic verification, insurance review, and intake support with outreach, consent, and enrollment duties specific to CCM. The representative serves as a professional and empathetic point of contact for patients, helps explain the program in patient-friendly language, ensures accurate documentation, and supports compliant enrollment workflows in accordance with CMS, HIPAA, and organizational standards.

About Complete Care Partners, LLC

Complete Care Partners helps patients navigate their health alongside their physician, gaining peace of mind and increase quality of life. At Complete Care Partners we recognize the value in taking care of one’s health and the relationship between the patient and their doctors. Our mission is to help patients and their families not only understand their chronic conditions and healthcare plan provided by their doctors, but to also make sure that they have someone to count on to provide quality service and knowledge when they need help.

Description

Patient Outreach and Communication

• Conduct proactive outbound calls, SMS messages, and emails to eligible patients.
• Clearly explain the purpose, structure, and benefits of Chronic Care Management in simple, patient-friendly language.
• Communicate professionally and empathetically, especially with older adult populations.
• Use approved scripts while maintaining a conversational and supportive tone.
• Answer general, non-clinical patient questions related to enrollment, program participation, scheduling, registration, and next steps.
• Escalate clinical questions, medical concerns, or scope-sensitive matters to licensed clinical staff.

Patient Access and Intake Functions

• Verify patient identity using approved procedures before discussing protected health information.
• Confirm and update patient demographics, contact information, emergency contacts, and insurance information.
• Support patient intake and registration processes related to CCM enrollment.
• Review eligibility information and assist with coordination of intake-related administrative requirements.
• Help patients understand communication preferences, consent steps, and documentation requirements.

Eligibility Verification and Consent

• Verify CCM eligibility according to CMS guidelines and organizational requirements.
• Deliver all required disclosures clearly before requesting enrollment consent.
• Obtain and accurately document informed consent using approved procedures.
• Ensure each enrollment includes complete and accurate verification and consent documentation.
• Identify, report, and flag discrepancies or inconsistencies in eligibility, identity, coverage, or patient information.

Documentation and Systems Management

• Enter patient data, insurance details, enrollment status, and interaction notes accurately into the electronic health record and other required systems.
• Maintain documentation that is complete, compliant, timely, and audit-ready.
• Navigate multiple systems simultaneously while maintaining accuracy and efficiency.
• Follow standardized workflows for outreach, registration, eligibility review, consent, and documentation.
• Report system issues, workflow barriers, or documentation concerns through the appropriate internal channels.

Compliance and Quality Standards

• Protect patient privacy and confidentiality in accordance with HIPAA and organizational privacy standards.
• Follow CMS regulations, organizational policies, and CCM program requirements.
• Maintain high quality and accuracy standards in patient interactions, registration, and enrollment documentation.
• Participate in compliance training, quality audits, coaching sessions, and workflow updates.
• Escalate any patient complaint, compliance concern, or clinical matter according to internal procedures.

Performance Expectations

• Meet or exceed monthly enrollment goals established by management.
• Maintain consistent daily outreach activity and complete assigned patient access and enrollment workflows.
• Demonstrate reliable attendance, punctuality, and professional communication.
• Maintain a distraction-free, HIPAA-compliant work environment if working remotely or in a hybrid setting.
• Adapt to changes in scripts, workflows, payer requirements, CMS guidance, and organizational priorities.

Qualifications

• One to two years of experience in patient access, patient registration, healthcare enrollment, medical intake, healthcare customer service, or a related healthcare administrative role.
• Strong communication and customer service skills, especially with older adult populations.
• Working knowledge of HIPAA, patient identity verification, insurance verification, healthcare terminology, and patient-facing communication standards.
• Ability to follow scripts, explain programs clearly, document accurately, and manage multiple systems at once.
• Comfortable working within electronic health records and related health information systems.
• Strong attention to detail, organization, and follow-through.
• Medical Administrative Assistant certification, equivalent training, or relevant work experience preferred.
• Bilingual skills preferred but not required.
• Ability to remain seated for extended periods and perform frequent phone and computer-based work.

Work Environment

• In-office position with structured workflows, standardized scripting, and clear operational guidelines.
• Performance is monitored through quality audits, productivity metrics, and coaching sessions.
• Role expectations, workflows, and responsibilities may change based on regulatory updates, program growth, and operational needs.

Disclosures

• This role involves access to protected health information and requires strict compliance with HIPAA, CMS, and all organizational privacy and security requirements.
• Job duties may be updated periodically based on CCM program changes, regulatory requirements, payer expectations, or internal policy revisions.
• Enrollment goals, productivity standards, and performance expectations may be modified according to organizational needs.
• Continued employment requires successful completion of required training, adherence to documentation standards, and maintenance of quality and compliance expectations.
• * The organization reserves the right to revise job expectations and responsibilities to support operational efficiency and regulatory compliance.
• We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or any other status protected under applicable law.

Salary

$14 - $18 per hour