Case Manager

2 weeks ago

Washington, United States Health Benefit Exchange Author Full time

**Duties**:
**DCHBX Social Justice Values Statement**

We believe in social justice and the power of diversity, equity, and inclusion, and are committed to fighting longstanding discrimination, racial injustice, and systemic racism to contribute to a more just and equitable future for our workforce, our customers, and our partners.

**Introduction**

This position is in the District of Columbia Health Benefit Exchange Authority (HBX). The mission of the HBX is to implement a health care exchange program in the District of Columbia in accordance with the Patient Protection and Affordable Care Act (PPACA), and the Health Benefit Exchange Authority Establishment Act of 2012, thereby ensuring access to quality and affordable health care to all District of Columbia residents.

**MAJOR DUTIES**

Assesses eligibility for enrollment and providing enrollment assistance in DC Health Link insurance products and Medicaid for individuals and families who have applied for or have had difficulty in accessing insurance information through the on-line insurance marketplace.

Initiates and establishes contacts with collateral resources within the DCHBX, such as the Eligibility and Enrollment team; agency legal staff; community-based In-person Assister organizations, and insurance carriers to identify and help resolve enrollment barriers.

Attends community meetings, workshops and special programs to disseminate information to District residents about DC Health Link programs and services.

Interfaces with community-based in-person assisters, federally qualified health centers, navigators and key stakeholder groups regarding case management services available for residents unable to enroll in insurance programs on their own.

Assist with identifying and communicating any change in Exchange eligibility and enrollment policies, federal or local regulations to residents seeking to enroll in various health insurance products.

Attend meetings and seminars on issues related to health insurance, health care reform, Medicaid, etc. that may impact eligibility, enrollment, tax credit eligibility, denial of coverage and appeals in the Health Benefit Exchange.

Responds to crisis situations, and attempts to resolve enrollment problems for individuals and families.

Participates in conferences, educational training and workshops, and remains fully informed in matters of the ACA and its implementation.

Maintains statistical data and updates case records which reflect current and accurate data of individuals and families served and the case management activities performed.

Answers correspondence from the public in reference to enrollment issues.

Completes reports and makes recommendations to HBX leadership for changes in enrollment procedures, as needed, to better serve consumers.

Performs other related duties as assigned.

**KNOWLEDGE REQUIRED BY THE POSITION**

**Knowledge of health coverage programs and eligibility (including Medicaid), operations, and policy required. **Knowledge of rules governing and compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the confidentiality of consumer information.**

**Skill in interviewing consumers, within the context of cultural competency considerations, in order to gather information pertinent to case services and resolutions or to facilitate escalation to HBX leadership for closure.**

**Ability to complete assignments/projects on time, prioritize multiple tasks, prepare work plans, and proactively seek out guidance on related project issues.**

**Ability to effectively communicate orally and in writing, in order to provide assistance to clients; to prepare reports; and to maintain contact with community, resource groups, and collaborative organizations.**

**SUPERVISORY** **CONTROLS**

The incumbent works under the general direction and administrative guidance of the Consumer Services Manager, who makes assignments and is available for policy guidance. The incumbent independently plans and carries out the assignments, resolving most conflicts that arise, but consults supervisor on controversial and

complicated cases. Completed work is reviewed from the standpoint of effectiveness of casework and support services provided in addition to meeting expected results.

**GUIDELINES**

Principal guidelines include: established District of Columbia laws, regulations, policies, and procedures, including HBX regulations, policies, and procedures; pertinent federal laws, regulations, policies, and procedures; and specific instructions from the Executive Director. Guidelines also include accepted public health and insurance principles and practices and authoritative guidance issued by the Center for Consumer Information and Insurance Oversight (CCIIO), and the Centers for Medicaid and Medicare Services (CMS). Incumbent exercises judgment and initiative in carrying out assignments, as well as interpreting and adapting guidelines to specific situations.

**COMPLEXITY**

Prov

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