Children's Special Healthcare Services Benefit Rep

Salary : $42,469.01 Annually

Location : Lansing, MI

Job Type : Regular Full Time

Job Number : 202400184

Department : Children's Special Health Ser.

Opening Date : 12 / 20 / 2024

Closing Date : Continuous

Bargaining Unit : UAW

Description

• Applications are accepted until there are sufficient numbers of qualified applications or qualified candidate has been identified. The position could possibly close at any time.

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 Functions

1. Assist 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.

2. 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.

3. 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).

4. 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.

5. 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.

6. 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 renewal of CSHCS coverage. Must make at least three attempts to contact each family / client using different avenues of communication (phone call, email, etc).

7. Maintains daily monitoring of messages sent from the State in the Document Management Portal (DMP). These messages are client specific and require various levels of investigation, intervention and outreach. Every action taken must be thoroughly documented in the ICHD client database. Medical and financial documents are also uploaded to the State using this secure system.

8. Perform various data entry and documentation activities. Maintains current client information in the ICHD database. Updates client details as needed. Updates MDHHS about known changes in client's demographic, medical, or financial details. Thoroughly documents each and every encounter and / or interaction with the family / client in order to accurately record the level of service provided to our families and clients.

9. Manage CSHCS mailbox. Reviews each item of mail and delegates to the PHN as appropriate for medical questions or information. Completes follow up on each item of mail as indicated and follow up on return mail by reaching out to family to obtain correct demographics information and updating this in all CSHCS systems.

10. Manage CSHCS phone line and voicemail system. Responds to client calls directly or through returned voicemail. Documents all phone conversation content and outcomes in the ICHD client database. Delegate to the CSHCS PHN as necessary.

11. Performs various client services as indicated. Prepare and submit Notice of Action (NOA) requests using DMP. Request release of information (ROI) when needed and instruct family / client on process for ROI. Alongside the CSHCS PHN, assists client / family with transition to adulthood process including : initiates the MDCH ROI form to assure HIPAA compliance for adult clients, provides information / instruction on process of requesting / acquiring guardianship, and legal documents involved in process of transition. Process and manage several types of non-emergent medical transport (NEMT) requests. Process and manage out of state (OOS) care travel and lodging requests. Manages and updates third party liability (TPL) as indicated by adding or removing insurance policy information. Collaborates with the court system on issues of guardianship, adoption and citizenship.

12. Order and maintain program supplies and educational materials. Maintain adequate supply of program brochures necessary for use and distribution at community outreach events.

13. Follow up on all CSHCS referrals from other ICHD programs. Assists with application process information for MIChild / Healthy Kids.

14. Attends community outreach events and presentations as needed.

15. All CSHCS program staff attend the MDHHS Annual Regional Meeting and the monthly CSHCS LHD meetings presented by State CSHCS staff.

16. All CSHCS staff assist in maintaining the minimum program requirements (MPR) as described in the CSHCS Guidance Manual written by the State CSHCS department. Each member of the team must perform their essential functions completely, with utmost attention to detail to ensure each MPR is met or exceeded.

17. All CSHCS staff will help prepare for CSHCS program accreditation which occurs on a 3-year cycle. The State CSHCS accreditation staff will contact each LHD with needs pertaining to accreditation and each LHD CSHCS program is responsible for delivering all materials and client records to the State as requested.

Other Functions :

The above statements are intended to describe the general nature and level of work being performed by people assigned this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.)

Employment Qualifications

Education : High school graduation or equivalent.

Experience : One year of general clerical experience is required. May require experience and training in various computer software and equipment. May require healthcare billing resolution experience. Medical terminology skill is beneficial.

Demonstrates effective communication skills by engaging, interacting and working with individuals from various cultural and socioeconomic backgrounds, disability status', ages, LGBTQIA status' and genders to ensure clarity and understanding in all interactions.

Other Requirements :

The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.)

Requirements and Working Conditions

Physical Requirements :

This job requires the ability to perform the essential functions contained in this description. These include, but are not limited to, the following requirements. Reasonable accommodations will be made for otherwise qualified applicants unable to fulfill one or more of these requirements.)

Working Conditions :

UAW F

2022

This position is benefited and is subject to the UAW GROUP CBA.

Ingham County offers a wide range of benefits to support you in your career. View the for more information.

The current group contract can be viewed

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Salary : $42,469