Benefits Eligibility Specialist (2)

Overview

The Benefits Eligibility Specialist is a responsible for educating, advocating and counseling clients and/or their authorized representatives in navigating Maryland state and federal insurance processes. This role serves as a subject matter expert on Medicaid and Medicare insurance, working closely with practice operations and billing staff to affirm insurance status and with clinical staff to provide consultation and guidance for client inquiries concerning insurance coverage.

Key Role Responsibilities

• Perform all duties of a Certified Application Counselor (BES I) or Certified Navigator (BES II) under the standards of the Maryland Health Benefits Exchange.
• Interview applicants to screen for benefits eligibility, verify identity, and to educate on required documentation and conditions to enroll, renew, modify and prevent loss of insurance coverage.
• Provide Health Choice/MCO Navigation and Medicare education in accordance with all state and/or federal guidelines, including explanation of plan options available, program functions, requirements and limiting conditions, affordability and cost-sharing structure, fees and penalties, as well as consumer rights. 
• Assist with enrollment into Qualified Health Plan (QHP) and Qualified Dental Plan (QDP) options, Insurance Affordability Programs, Medicare, Medicare Savings programs (Qualified Medicare Beneficiary and Specified Low-Income Medicare Beneficiary).
• Assist eligible clients with completing applications, securing supporting documentation and filing insurance applications. Monitor and track client application, enrollment and dates of coverage; conduct timely follow-up on cases and/or accounts, which includes making phone calls to clients or authorized representative to obtain missing information or items. 
• Consistently, accurately and appropriately enter information into the electronic health record, Maryland State Connection portal, NGS Connex (Medicare) and Managed Care Organization portals. 
• Answers phone calls in a timely manner and responds to all voicemails within one business day to ensure appropriate follow up for client cases. 
• Ensure timely behavioral health prior authorizations are approved for clients per MCO rules and before services are delivered. 
• Participate in continuing education training sessions, certification maintenance and periodic insurance update meetings as required by State of Maryland.
• Maintain strictest of confidentiality of client and business information; comply with rules, regulations, policies and procedures of all applicable agency, local, state, federal and regulatory bodies.
• Maintain expertise in eligibility and enrollment rules and procedures; the range of qualified health plan options and insurance affordability programs; the needs of underserved and vulnerable populations; and privacy and security standards.

Key Agency Responsibilities 

In addition to role responsibilities, each staff member of Health Care for the Homeless has the following responsibilities as a part of their employment:

• Models and reinforces the Health Care for the Homeless core values of dignity, authenticity, hope, justice, passion and balance
• Participates in performance improvement and advocacy activities that support the mission 
• Performs other duties on an as-needed basis
• Protects clients’ personal health information by maintaining compliance with HIPAA and other relevant health care related IT security regulations

Knowledge, Experience, and Skills 

Formal Education and Training

• High School Diploma or GED required
• Certified Application Counselor, or able to obtain certification within first six months of hire (BES I)
• Certified Health Navigator, or able to obtain certification within first six months in role (BES II)
• Appropriate certification is required as a condition of continued employment

Experience  

• One year of experience working with insurance eligibility/verification or similar role required (BES I)
• Two years of experience required (BES II)
• Experience in a community or public health setting working with an underserved population is highly preferred
• Experience working with multiple line telephone systems, computers and practice management systems required
• Bilingual (Spanish) highly preferred 

Skills 

• Excellent customer service, with ability to clearly communicate verbally and in writing.
• Must be able to maintain confidentiality in all circumstances.
• Must be able to remain calm in highly inflammatory circumstances, providing and taking clear direction and maintaining a respectful demeanor.
• High level of motivation, initiative and responsibility.
• Able to work with interdisciplinary teams
• Able to cope with interruptions, be flexible and be a team player

Health Care for the Homeless is an equal opportunity employer