Purpose : Complete required intake, eligibility and enrollment processes with all HIV patients and complete internal referrals to all Trillium services for which the patient is eligible. Provide input for the Director, Care Management to assess caseload assignment and assure a seamless transition to the assigned Medical Case Manager.
Key Job Responsibility Areas
- Patient Insurance Verification
- Ryan White Part C Enrollment and Recertification
- Coordinate & Track Supportive Services Referrals
- Sliding Fee Scale
- Cross-Departmental Support / Collaboration
- Case Management Services
- Miscellaneous
Detail of Key Job Responsibility Areas
1. Patient Insurance Verification
Ensure patient demographics are maintained with updated information.Assess patient for eligibility for Medicaid, Medicare, and private insurance available through ACA marketplace and assist patients in applying for assistance as needed.Assist patient with applying for ADAP insurances as appropriate.Assist patients in applying for insurance assistance during ACA open enrollment.Populate "know your coverage" scorecard and educate patient on information in scorecard.2. Ryan White Part C Enrollment and Recertification
Act as the point of contact for new HIV patients / clients and schedule Intake appointment and new patient / client appointment with appropriate provider(s).Meet with new HIV patients / clients prior to provider appointment to complete HIV Services Intake, obtain required eligibility documentation and complete enrollment into Ryan White Part C program, as appropriate.Track intake information as required and assure a smooth transition to an assigned Medical Case Manager.Complete recertification of Ryan White Part C enrollment as required. At each recertification, determine the patient's level of Ryan White Sliding Fee Scale and Cap on Charges and educate patients about these benefits.Monitor patient progress toward Ryan White Cap on Charges and adjust a patient's cap in coordination with Billing and document it consistently in the electronic medical record as needed.Educate patient on Ryan White program services and Supportive Services based on availability of those services as well as patient eligibility, interest and needs.3. Coordinate and Track Supportive Services Referrals
Triage HIV Services Intake document to all programs the patient / client is eligible for and interested in, to initiate internal referral into those programs.Enter all the internal referral information into the electronic medical record system.Keep track of patient / client service referrals in the system and follow up with clients who have missed internal referral appointments.4. Sliding Fee Scale
Interpret and apply sliding fee scale for Ryan White Sliding Fee ScaleEnsure documentation related to sliding fee scale is accurately and consistently captured in electronic medical record.Notify the Eligibility team to complete the sliding fee process.Responsible for educating patients and prospective patients on Ryan White sliding fee scale.5. Cross-Departmental Support / Collaboration
Collaborate with Front Office Teams to coordinate enrollment and eligibility follow-up as needed.Collaborate with Eligibility and Enrollment Specialists to ensure responsibilities regarding patient eligibility and enrollment are completed per agency and funder expectations / procedures.Work with Supportive Services teams to facilitate enrollment into programs based on patient eligibility, interest and needs.6. Case Management Services
May provide Medical Case Management services on a very time limited basis to support continuity.7. Miscellaneous
Requires the ability and commitment to respect and support inclusiveness and diversity including but not limited to individuals of different backgrounds, cultures, races, ages, sexual orientations, gender identities or expressions, experiences, opinions, etc.Requires individual demonstration of commitment to the One Trillium behaviors and business impacts and modeling them in the organization.Responsible for maintaining confidentiality of all patient, client and employee protected and proprietary information.Employees are accountable for meeting the performance standards of their departments and must participate as requested in compliance audits, process improvement and quality improvement plans.Other duties as assigned.Qualifications
Bachelor's degree required. At least two (2) years of experience in human services / medically based setting required. Benefit advisement experience preferred. Knowledge of sliding fee scale. Knowledge of insurance options preferred.
Competencies
Effective performing multiple tasks during workday.Proficiency in MS Office and computer / automated systems for data purposes.Proficiency with electronic medical records systems.Excellent organization, communication and interpersonal skills a must with the ability to communicate effectively verbally and in writing; and utilize good listening skills.Ability to work effectively in a collaborative, team-based work environment, including the ability to positively receive and give constructive feedback.Ability to function autonomously as a worker and as a team member on a multidisciplinary teamPhysical Requirements
While performing the duties of this job the employee is required to stand, sit, walk. Occasionally the employee must stoop, bend and lift or move up to 25 lbs.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
