KY Medicaid Enrollment Specialist

Position Summary:

The KY Kynector / Certified Application Counselor (CAC) – Medicaid Enrollment Specialist serves as a critical resource in assisting patients, families, and community members with applying for Medicaid and other health coverage programs through the Kentucky Health Benefit Exchange (kynect). This role supports timely access to care by guiding individuals through the enrollment process, reducing barriers to coverage, and ensuring accurate and compliant application submission.

This position plays a vital role in bridging gaps in access to care by helping vulnerable populations navigate eligibility requirements, documentation needs, renewals, redeterminations, and system processes. The position works collaboratively with the business office, case management, intake, clinical teams, and community partners to identify uninsured or underinsured individuals and connect them to appropriate coverage resources. Services are provided in accordance with KHBE, kynect, HIPAA, and applicable state and federal requirements, and are provided at no cost to applicants as required under program guidelines.

Position Responsibilities:

Clinical/Technical Skills (40% of performance review)

Provides one-on-one assistance to patients, families, and community members completing Medicaid and other health coverage applications through kynect.
Gathers and reviews required documentation, including income, identification, residency, and other eligibility-related information, to support complete and accurate application submission.
Tracks application status and assists with follow-up actions, renewals, eligibility redeterminations, and documentation requests.
Educates patients and families on Medicaid eligibility, benefits, coverage options, managed care processes, and next steps in the enrollment process.
Supports individuals who may face barriers such as limited health literacy, limited access to technology, transportation challenges, or complex social circumstances.
Provides culturally competent, trauma-informed, and patient-centered support throughout the enrollment and follow-up process.
Collaborates with the business office, case management, intake, discharge planning, and clinical teams to identify uninsured or underinsured patients in need of coverage assistance.
Participates in discharge planning as appropriate to promote continuity of coverage and reduce barriers to post-discharge care.
Helps streamline internal workflows to improve timely Medicaid approvals and reduce delays in access to care.
Maintains accurate documentation of patient encounters, application activities, follow-up steps, and outcomes in accordance with organizational procedures.
Maintains compliance with KHBE, kynect, HIPAA, and applicable state and federal requirements governing Certified Application Counselors.
Ensures enrollment assistance services are provided at no cost to applicants as required by program guidelines.
Assists with onsite or community-based Medicaid enrollment and outreach efforts as needed.
Builds collaborative relationships with internal teams and external partners to improve access to Medicaid enrollment services.
Identifies and recommends process improvements related to Medicaid enrollment workflows, documentation, and patient access.
Performs other duties as assigned.

Safety (15% of performance review)

Strives to create a safe, healing environment for patients and family members
Follows all safety rules while on the job.
Reports “near misses”, as well as errors and accidents promptly.
Corrects minor safety hazards.
Communicates with peers and management regarding any hazards identified in the workplace.
Attends all required safety programs and understands responsibilities related to general, department, and job specific safety.
Participates in quality projects, as assigned, and supports quality initiatives.
Supports and maintains a culture of safety and quality.

Teamwork (15% of performance review)

Works well with others in a spirit of teamwork and cooperation.
Responds willingly to colleagues and serves as an active part of the hospital team.
Builds collaborative relationships with patients, families, staff, and physicians.
The ability to retrieve, communicate, and present data and information both verbally and in writing as required
Demonstrates listening skills and the ability to express or exchange ideas by means of the spoken and written word.
Demonstrates adequate skills in all forms of communication.
Adheres to the Standards of Behavior

Integrity (15% of performance review)

Strives to always do the right thing for the patient, coworkers, and the hospital
Adheres to established standards, policies, procedures, protocols, and laws.
Applies the Mission and Values of SUN Behavioral Health to personal practice and commits to service excellence.
Supports and demonstrates fiscal responsibility through supply usage, ordering of supplies, and conservation of facility resources.
Completes required trainings within defined time periods.
Exemplifies professionalism through good attendance and positive attitude, at all times.
Maintains confidentiality of patient and staff information, following HIPAA and other privacy laws.
Ensures proper documentation in all position activities, following federal and state guidelines.

Compassion (15% of performance review)

Demonstrates accountability for ensuring the highest quality patient care for patients.
Willingness to be accepting of those in need, and to extend a helping hand
Desire to go above and beyond for others
Understanding and accepting of cultural diversity and differences