Benefits Specialist; Outreach & Enrollment

JOB SUMMARY

Facilitates comprehensive linkage and follow-up between clients and staff, and the Cuyahoga County Department of Human Services, Social Security, the Marketplace, The Children’s Health Insurance Program (CHIP) and other organizations that provide benefits. The responsibilities and duties of this position include, but are not limited to, researching client’s current Medicaid status, working with the consumer to obtain and/or maintain their benefits and entitlements, coordinating the Medicaid application process, and collaborating with other members of a client’s treatment team.

ESSENTIAL JOB DUTIES & RESPONSIBILITIES

• Provides clients with information and assistance regarding entitlements
• Explains eligibility.
• Assists clients with completing forms/applications/referrals and submits documentation.
• Works with clients to complete agency Financial Investigation process (FEE).
  • Explains financial contract to clients.
  • Verifies insurance coverage and obtains documentation of insurance coverage.
  • Applies sliding fee when appropriate.
  • Completes ADAMHS “Shares” program process including Diagnostic entry and UCI billing numbers, when appropriate.

• Actively works to ensure continued benefits for clients.
  • When possible serves as authorized representative for Medicaid and/or Food Assistance on behalf of client.
  • Assists client through Medicaid and or Food Assistance redetermination process through tracking, meeting attendance, and completion of redetermination process.
  • Provides follow up to confirm establishment of benefits.

• Conducts patient interviews and completes sliding-fee discount applications for those who do not qualify for public benefits. Monitors the volume of patients on sliding fee discount program and track hardship request for those who find co-pays and deductibles a barrier for accessing care.
• Provide outreach and education to raise awareness about the Marketplace and refer consumers to health insurance ombudsman and consumer assistance programs when necessary.
• Conduct public education activities to raise awareness about coverage options available under Medicaid, CHIP, and the Marketplace.
• Provide referrals to any applicable office of health insurance consumer assistance or ombudsman established under Section 2793 of the PHS Act to address consumer grievances, complaints, or questions about their health plan, coverage, or a determination.
• Acts as the agency’s liaison with the Department of Human Services, ODJFS and/or other service providers that will assist clients with obtaining the entitlements. Develops professional relationships with other service providers, especially with other agencies that are providing services and/or entitlements to mentally ill individuals. Demonstrates a sensitivity and responsiveness to clients’ ethnic, cultural, and development background.
• Assists case managers with any needs regarding entitlements; actively communicates on current status of entitlements.
• Engages in accurate and timely record keeping in agency EMR.
• Provides assistance and consultation to staff regarding entitlement questions.
• Attends continuing education trainings, as directed by their supervisor.

OTHER DUTIES

• Performs other duties as assigned.

JOB QUALIFICATIONS

• HS diploma or equivalent and related experience in working with entitlements.
• Demonstrate and maintain expertise in eligibility and enrollment rules and procedures.
• Must have training in the Marketplace and have passed the test for Certified Application Counselors in preparation for the current year open enrollment.
• Know and understand the range of qualified health plan options and insurance affordability programs.
• Possess a valid Ohio driver’s license.
• Supports the organization’s overall mission and values including initiative, teamwork, and flexibility. Supports agency’s philosophy, values and goals, and is conscientious about all organizational values. Is ethical in all interactions with the organization’s staff and external parties
• Adheres to the ethical, confidentiality, and professional standards of federal and state law, employment policies, and the policies of appropriate licensing and credentialing boards.
• Must have sensitivity in relating to persons of varying backgrounds and to those who have experienced psychiatric problems.
• Ability to maintain appropriate and required confidentiality ensuring the integrity of sensitive information (written and/or verbal).
• Ability to work on a variety of projects concurrently.
• Ability to handle a diversified workload.

COMPETENCIES:

• Communication - Able to present ideas to groups of people in a manner that is understandable and appropriate to the audience level; expresses self clearly in writing; able to take complex benefit issues and make them understandable based on the audience’s knowledge and experience. 
• Customer Focus - Dedicated to meeting the expectations and requirements of internal and external customers; gets first-hand customer information and uses it for improvements in products and services; acts with customers in mind; establishes and maintains effective relationships with customers and gains their trust and respect. 
• Values Diversity: Collaborates with and involves others, demonstrating a respect for divergent viewpoints; interacts well with diverse people and groups, thereby contributing to an environment that is equitable, inclusive, and cooperative. An awareness of and sensitivity to the cultural diversity of the population served. 
• Time Management – Uses time effectively and efficiently, values time, and concentrates efforts on the more important priorities. 

The Centers is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status, or any other characteristic protected by law.