Children's Special Healthcare Services Benefit Rep

The CSHCS Benefit Representative provides comprehensive community centered care to both active CSHCS clients as well as prospective CSHCS clients. The CSHCS Benefit Representative maintains a caseload of varying number due to the consistent addition and removal of clients that occurs on a regular basis. All staff working with the CSHCS program must understand the complexities of the program in order to assist clients and community partners with understanding and utilizing the full benefits that the program can provide to those who qualify. This includes assistance with medical eligibility, financial eligibility, release of information, diagnostic evaluation, program enrollment, billing process and issues, transportation / lodging reimbursement, referral of resources, out of state care and travel, and renewal of coverage. Families eligible for CSHCS coverage have unique and complex situations due to a child with special medical healthcare needs. The CSHCS staff must traverse through the program requirements while simultaneously providing emotional support and empathy to each family / client. The CSHCS Benefit Representative maintains a close working relationship with the CSHCS public health nurse in order to ensure all CSHCS clients are obtaining maximum benefits from the program. The CSHCS Benefit Representative has an integral role in helping the CSHCS program at the LHD to maintain minimum program requirements as dictated in the CSHCS Guidance Manual.Essential FunctionsAssist new clients with the process of enrollment by mailing various types of ICHD CSHCS welcome / invite letters, a notice of information practices sheet, the rights and responsibilities sheet and travel reimbursement instructions to the family. Creates a client profile in the ICHD CSHCS database. Enters insurance information into the state third party liability database as needed. Assists clients who are issued temporary coverage with application for Medicaid. Assists clients with completing the enrollment application as needed.Performs care coordination services to appropriate clients as needed. Care coordination involves complex handling of various issues and situations, including help with billing issues that often requires multiple lengthy communications with various community partners, members of billing staff, insurance staff and CSHCS State level program experts. Care coordination billing is entered into Children's Healthcare Automated Support Services (CHASS) and the CSHCS Benefit Representative must employ professional judgment to determine the level of billing that is appropriate for each situation.Manages the Income Review Payment Agreement (IRPA) process for clients who are not enrolled in Medicaid or a Medicaid Health Plan. Obtains a financial assessment / IRPA amendment if family / client income has changed or when requested by Lansing Regional Office (LRO).Maintains current access to the State CSHCS database through MiLogin. Uses this system to access client information pertaining to things such as update to client demographics, medical eligibility, coverage dates, letters sent to client, provider eligibility and client's approved diagnoses and providers. Reprints Client Eligibility Notice (CEN) and payment agreement coupons as needed using MiLogin. Uses NPPES-NPI registry to review provider credentials and request specialty providers be added to the CEN.Run reports accessed through MiLogin CSHCS that are specific to our local health department. Use reports to monitor rate of renewal and non-renewal, enrollment, client expenditure, and active clients. Reports to ICHD Administration on Medicaid outreach services.From MiLogin CSHCS database, runs LHD 3rd Month report to ensure every client is contacted by our CSHCS LHD program at least once annually to update contact information, financial information, insurance information and to discuss what is needed for