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Eligibility Specialist

3 months ago

Las Vegas, United States Access To Healthcare Network Full time
Job DescriptionJob Description

Best Place to Work in Northern Nevada - 1st Place Winner 2024
Best Place to Work for Working Parents - 2024

Check out our AWESOME Benefits

  • 4 weeks Paid Time Off in the First Year - Front Loaded
  • 14 paid holidays annually
  • Hybrid Work Options Available
  • 403B Retirement Plan with 4% Match
  • 4 Weeks Paid Parental Leave
  • Up to 4 Weeks Paid Catastrophic Leave
  • Medical, Dental, and Vision benefits - effective 1st DAY OF THE MONTH, following date of hire
  • Free Health Insurance Options for Full Time Employees
  • Low-Cost Health Insurance Options for Dependents
  • Health Reimbursement Account
  • Employee Hardship Loan Program
  • Free Life Insurance and Long-Term Disability
  • Tuition Assistance
  • Continuing Education Support
  • Dog Friendly Workplace
  • Child Friendly Workplace
  • Great Organizational Culture

Job Purpose: The Ryan White Eligibility Specialist will help improve the health outcomes for clients living with HIV/AIDS, providing eligibility determination services and assisting clients to obtain access to other public and private programs by enrolling into Ryan White. The Ryan White Eligibility Specialist will determine payer source for ADAP services. This entails ensuring that RW members are meeting their obligations to AHN, to our providers and to the Grantors of the program. The Eligibility Specialist will also advocate, and problem solve on behalf of our consumers to ensure that they receive a continuum of care and support. Ensuring this continuum of support requires that the Eligibility Specialist complete all funding guidelines and reporting requirements. The Eligibility Specialist will assist with scheduling appointments, maintaining spreadsheets, assisting with high call volume, as well as determining and tracking payer sources for ADAP services. The Eligibility Specialist will assist in the development and continual improvement of the Access to Healthcare Network Ryan White Program.

Key Responsibilities and Accountabilities:

  • Eligibility screening for potential Ryan White services to ensure clients are eligible for assistance.
  • Assist clients in filling out the Ryan White application for initial certification and semi-annual recertification.
  • Assist consumers in filling out the Ryan White Liberty Dental Application for enrollment for all eligible consumers.
  • Gain a clear and working knowledge of the HIV/AIDS Drug Assistance Program (ADAP); establish and maintain appropriate working relationship with persons and agencies involved.
  • Gain clear and working knowledge of granting NMAP (ADAP) dates based on payer of last resource rule (30 days vs full NMAP dates).
  • Learn, and follow, the payer of last resort rule at all times.
  • Prescreen client for the HIP program to see if they qualify for any assistance (enrolling into on or off exchange, help with Health Insurance Premiums, co-pays or deductibles, tax program, etc.).
  • Assist in providing EIVF to consumers and sending a referral to HIP for follow-up for obtaining this document to obtain payer of last resort proof.
  • Have a working knowledge of non-AHN health care programs such as Medicaid, Medicare, Nevada Check-Up, Prescription Drug Programs.
  • Follow up with clients for missing documents preventing the completion of eligibility renewals.
  • Completing the process of updating interim eligibility changes by obtaining proof of the changes, updating the application and all systems.
  • Fulfill parts of the Scope of Work for the Nevada Department of Health and Clark County Nevada.
  • Complete CareWare A/B and RWISE data entry and application uploads for all eligibility applications completed by the eligibility specialists by end of business day.
  • Complete CareWare A/B and RWISE data entry and application uploads for all eligibility updates completed by the eligibility specialists by end of business day.
  • Refer clients to Non-Medical Case Managers for any AHN, community partners or outside agency referrals needed (any service outside of eligibility or liberty dental).
  • Assist with obtaining and entering labs (CD4 count and Viral Load) into CareWare A.
  • Ability to be both compassionate and professional while serving the program population.
  • Return all phone calls, emails or written correspondence within 48 hours of receipt.
  • Schedule future eligibility appointments for consumers before they leave their appointment.
  • Submit all programmatic reports on time, in a professional format and with accurate data.
  • Gain clear and working knowledge of Access to Healthcare Network services available to our members and be able to use the AHN database to locate information and perform basic job functions.
  • Process, maintain and gather protected health information from clients in a manner compliant with all HIPAA regulations.
  • Develop and maintain effective working relationships with AHN providers, members, program partners and program funders.
  • Be able to multitask and critically think though a variety of situations.
  • Must be proficient in Microsoft Office, particularly Excel, Word and Outlook.
  • Abide by all HIPAA requirements.
  • Must attend staff meetings and be willing to meet with direct supervisor on a consistent and regular basis.
  • Gain a clear and basic knowledge of Access to Healthcare Network
  • Gain a clear working knowledge of CareWare A/B and RWISE.
  • Gain a clear and basic knowledge of Magellan.
  • Gain a basic and clear working knowledge of the Mitel phone system answering calls, transferring calls, answering voicemails, etc.
  • Gain a basic and clear working knowledge of Salesforce.
  • Ability to be both compassionate and professional with staff and partner agencies.
  • Ability to adapt to changing work environment and duties.
  • Other duties as assigned.

OTHER REQUIREMENTS:

  • Perform general administrative duties for Access to Healthcare Network when needed and/or requested.
  • Field inquiry calls from interested parties, including potential members. Explain program requirements, in both the Ryan White Part B Eligibility Program and the Ryan White Part A Eligibility Program. Make timely disposition of calls and take appropriate actions on inquiry calls and referrals.
  • Gain a clear and working knowledge of all Access to Healthcare Network administrative duties.
  • Flexibility, each department selects the hours of work schedule for the department staff based on the department's needs. This schedule may change at any time according to the department's needs.
  • Gain a clear and working knowledge of the Nevada Check-Up, Medicare, ACA and Medicaid enrollment criteria and process; establish and maintain appropriate working relationship with persons and agencies involved.
  • Complete appropriate copying, faxing and large-scale mailings.
  • Required to pass a background check through the State of Nevada.
  • Subject to Medicare/Medicaid fraud background check.
  • Required to obtain a Community Health Worker course Certification within the first year of employment at the agency's expense.
  • Must be able to obtain an Exchange Enrollment Facilitator License (EEF) at the agency's expense.

QUALIFICATIONS:

  • Spanish bilingual preferred.
  • Minimum Education: High School Diploma; AA Degree Preferred.
  • One year minimum working in health care related social work, with experience in medical billing and patient coordination preferred.
  • One year minimum general office duty experience such as typing, filing, and faxing.
  • Two years' experience working with databases and software programs such as Microsoft word, excel, PowerPoint and Vision.
  • Excellent organizational skills.
  • Be able to sit at a computer for 6 - 8 hours per day.
  • Be able to stand between 3 - 6 hours per day.
  • Be able to withstand hand/wrist deviation and repetition.
  • Excellent communication and customer service skills.
  • Must have a valid driver's license and be able to drive the AHN Company Car when needed.
  • Must be able to lift, carry up to 30 pounds with a fair consistency.
  • Flexibility, each department selects the hours of work schedule for the department staff based on the department's needs. This schedule may change at any time according to the department's needs.

Work Environment

  • The noise level in the work environment is usually moderate and the employee usually works in a climate-controlled office environment.

*The statements herein are intended to describe the general nature and level of the position, but are not necessarily a complete list of responsibilities, duties and skills required of employee(s) so classified. As such, responsibilities, duties, and required skills may be changed, expanded, reduced, or deleted to meet the business needs of Access to Healthcare Network. Furthermore, they do not establish a contract or implied contract for employment.

As an equal opportunity employer, we are committed to identifying and developing the skills and leadership of people from diverse backgrounds. We encourage all qualified candidates to apply.