Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB
The Advocacy and Enrollment Coordinator is responsible for coordinating complex member service operations related to enrollment, member advocacy, case navigation, and member engagement initiatives. This position supports Driscoll Health Plan’s mission by improving access to care, ensuring regulatory compliance, enhancing member satisfaction, and promoting retention through effective outreach and resolution of member needs.
The coordinator serves as a cross-functional resource to internal departments and supports operational excellence through reporting, trend analysis, workflow coordination, and continuous process improvement.

ESSENTIAL DUTIES AND RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the Director of Member Services and Outreach.

GENERAL RESPONSIBILITIES:
Assists departmental leadership in ensuring all processes and workflows are accurately completed for enrollment, member advocacy, case navigation, and member engagement functions.
Supports the identification, tracking, and analysis of trends, discrepancies, and
operational opportunities related to member services and enrollment activities. Assists with the coordination of member inquiries, complaints, appeals, and state fair hearing activities.

Supports the preparation, execution, and timely completion of departmental deliverables, projects, and initiatives.

Demonstrates ethical business practices and personal conduct consistent with corporate compliance and integrity standards.
Tracks, gathers, and analyzes data to prepare reports and summaries in support of member-related functions and leadership decision-making.
Adheres to all Health System and Health Plan policies, procedures, and regulatory requirements.
Maintains the highest level of confidentiality at all times.
Collaborates cross-functionally with internal departments to support operational efficiency and member satisfaction.
Performs other duties as assigned by the Director of Member Services and Outreach and Manager of Eligibility and Enrollment.

Member Engagement & Retention
Assists with oversight of outbound retention call campaigns designed to improve member engagement, renewal completion, and health plan retention.
Supports development and execution of member retention strategies focused on reducing churn and strengthening long-term member relationships.
Conducts proactive outreach through approved communication channels to encourage participation in programs and utilization of available services.
Identifies barriers impacting enrollment, retention, or member engagement and escalates trends or concerns to leadership for action planning.
Provides recommendations to enhance outreach messaging, communication timing, and engagement strategies to improve member response rates and program participation.

Member Advocacy Responsibilities
Provides strategic oversight and coordination of the Member Advocacy Program to ensure member needs are effectively addressed and all HHSC contractual requirements related to complaints, appeals, member rights, and responsibilities are fully met.
Leads and guides advocacy staff in resolving complex member concerns, including but not limited to PCP changes, access to care barriers, quality of care issues, claims and billing disputes, and service denials.
Ensures all member cases, concerns, and resolutions are thoroughly documented in accordance with regulatory, audit, and organizational standards.
Oversees processes that ensure members are appropriately informed of and assisted with:
o Member rights and responsibilities
o HHSC Office of the Ombudsman functions and contact information
o Complaint and appeal procedures
o Covered benefits, including preventive services
o Available non-capitated services and additional resources

Coordinates cross-functional resolution efforts with Quality Management, Operations, Provider Relations, and other internal departments to ensure timely and compliant handling of complaints, appeals, and quality referrals.
Analyzes advocacy trends, recurring member concerns, and service barriers, providing recommendations to leadership to improve member experience, operational workflows, and access to care outcomes.
Assists with preparation and submission of required reports, regulatory documentation, and internal administrative deliverables, ensuring accuracy, timeliness, and compliance.
Supports leadership in developing performance standards, workflow enhancements, and service strategies that strengthen member satisfaction and organizational performance.

Case Navigation Responsibilities
Assists with coordination and operational support of the Case Navigation Program to ensure Medicaid members’ care needs are addressed effectively and regulatory requirements related to member interactions are consistently met.
Supports the coordination, monitoring, and resolution of member cases to ensure timely access to appropriate care services while identifying and addressing barriers to care.

Assists with member education initiatives related to Medicaid benefits, available services, and healthcare system navigation to improve member understanding and engagement.
Ensures member interactions, care coordination activities, service requests, and case outcomes are accurately documented in accordance with organizational, regulatory, and audit standards.
Monitors case records, workflow productivity, and service metrics, providing regular updates and insights to leadership.
Conducts quality assurance reviews of CRMs and case documentation and recommends corrective actions to improve service quality and member experience.
Coordinates escalations for complex or high-priority member issues, ensuring prompt resolution through collaboration with internal departments and external partners.
Provides guidance and day-to-day support to Case Navigators, assisting with complex cases and workflow consistency.
Identifies trends, service gaps, and process improvement opportunities, recommending strategies that strengthen continuity of care, member satisfaction, and program performance.

Program Oversight & Enrollment Support
Assists with oversight and coordination of Loss of Eligibility and Disenrollment programs aimed at supporting members in maintaining continuous coverage and reducing avoidable disenrollment.
Supports Pregnant Member and Newborn Welcome messaging initiatives to ensure timely outreach, education, and connection to available benefits and resources.
Coordinates enrollment support for educational classes and wellness initiatives offered through Value Added Service (VAS) programs.
Guides members through enrollment processes, ensuring a clear understanding of program benefits, eligibility requirements, and next steps for participation.

Tracks enrollment activities, outreach outcomes, and follow-up actions within designated internal systems.

Data Tracking & Analysis
Coordinates with Communications, Value Added Services, Member Services, and other internal departments to execute, track, and measure member outreach campaigns, retention initiatives, and program enrollments.
Monitors key performance indicators including engagement rates, response rates, enrollment conversions, retention outcomes, and overall campaign effectiveness.
Oversees reporting for Loss of Eligibility, disenrollment prevention, Pregnant and
Newborn Welcome messaging, educational class participation, and other member engagement initiatives.
Partners with internal teams to align data needs, campaign targeting, member
segmentation, and performance metrics to ensure accurate and consistent reporting.
Analyzes outreach, retention, and program participation data to identify trends, service gaps, and opportunities to improve member engagement and coverage continuity.
Prepares reports, dashboards, executive summaries, and actionable insights for
leadership to support strategic, data-driven decision-making.
Recommends improvements to messaging, outreach timing, campaign strategies, and member response rates based on performance outcomes.
Identifies opportunities to enhance enrollment processes, retention strategies, outreach effectiveness, and the overall member experience.
Provides recommendations based on frontline member interactions, operational findings, and performance data to strengthen service delivery and program outcomes.
Supports testing and evaluation of new outreach methods, communication strategies, engagement tactics, and retention initiatives.
Assists leadership with process redesign, workflow enhancements, and innovation strategies aligned with departmental and organizational goals.

Supervisory Responsibilities
Provides day-to-day guidance, mentorship, and workflow support to Member Advocates, Case Navigators, Enrollment staff, and other assigned team members under the direction of departmental leadership.
Assists the Manager with coordinating daily operations to ensure departmental
workflows, service standards, and productivity expectations are consistently met.
Supports the timely completion of monthly, quarterly, annual, and ad hoc deliverables, ensuring accuracy and adherence to deadlines.
Assists with preparation, tracking, and timely submission of required HHSC reports, regulatory filings, and internal reporting requirements.
Maintains working knowledge of Health System and Health Plan policies, procedures, and compliance standards, helping ensure consistent application across the team.
Supports performance management activities by providing coaching, training,
developmental feedback, and monitoring staff competencies, while escalating personnel matters to the Manager as appropriate.

Assists with onboarding, cross-training, staff engagement efforts, and workflow coverage planning to support departmental operations.
Provides strategic recommendations to the Manager on process improvements,
operational efficiencies, and service enhancement initiatives that support departmental objectives and organizational goals.
Maintains professionalism, composure, and flexibility while managing multiple priorities and responding to changing business needs.

EDUCATION AND/OR EXPERIENCE
Bachelor’s degree (B.A.) from four-year College or university required; or 3-5 years related experience and/or training; or equivalent combination of education and experience.
Master’s degree preferred in Health Administration, Business, Economics, Health Sciences, Social Work.
Minimum of 2-3 years supervisory experience required.

Working knowledge of current Medicaid guidelines.

Experience in community action and organizing community events required.
Comfort with public speaking and an ability to meet with people and groups with diverse backgrounds.
Excellent community and people skills.

Communicate effectively in oral and written communication, trains others, maintain records, and prepares concise reports.