Patient Benefits Enrollment Specialist Level 1

3 weeks ago

Dorchester, United States Uphams Corner Health Center Full time
Job Details

Job Location
415 Columbia Rd - Dorchester, MA

Patient Benefits Enrollment Specialist

Position Title: Patient Benefits Enrollment Specialist
Supervisor: Patient Services Supervisor
Status/Hours per week: Full Time/Non-Exempt (40 hours/week)

Primary Function:
The Patient Benefits Enrollment Specialist assists uninsured and under-insured patients to apply for the most comprehensive government-sponsored health insurance coverage that they qualify for based on family size, family income, and immigration status. In addition to eligibility assistance, this position also assists patients with selecting and enrolling in an insurance plan, selecting a PCP, and setting up premium payments, as applicable. This position is required to receive the Massachusetts CAC (Certified Application Counselor) certification within one month of employment.

Duties & Responsibilities:
o Screen patients for basic eligibility into Massachusetts government-sponsored health coverage programs, such as MassHealth, HSN, Health Connector, etc. by checking residency, income and family size.
o Assist patients in accurately and comprehensively completing MassHealth applications on-line and for seniors (65 and older) paper applications.
o Assist patients with the MassHealth re-determination process to minimize any disruptions in coverage through proactive outreach from lists from C3 and other sources as well as through patient walk-ins.
o Assist patients with billing issues and notices received from MassHealth, Connector Care, and other insurance plans.
o Troubleshoot issues for patients such as lost or stolen insurance cards, requesting updates to information in the system, etc.
o Schedule patient appointments in Benefits accurately; proactively perform quality reviews of the Benefits schedule and make changes as needed, outreaching patients well in advance.
o Process daily productivity tracking and timely completion of Benefits reports.
o Obtain and maintain certification with Massachusetts CAC (Certified Application Counselor).
o Assist patients in completing the Sliding Fee Discount Application as requested or applicable. Complete accurate data entry of the sliding scale into OCHIN; assures UCHC is audit-ready in collaboration with leadership.
o Assist patients with other eligibility programs, such as Medicare Part D Prescription Drug Coverage through research using Medicare's website; and assist patients with the Medicare and MassHealth Open Enrollment periods.
o Attend MassHealth Training Forums and other relevant meetings and trainings to stay updated on all changes to the government-sponsored health coverage programs.
o Conduct outreach patients that do not keep their Benefits appointments.
o Educate patients about UCHC's Senior Care Options (SCO), PACE (Program or All-Inclusive Care), and other programs (Advocates, HIV, etc.)
o Availability and willingness to work evenings and/or Saturdays.
o Handle other duties as needed or assigned.

Experience and Qualifications

Basic Knowledge:
  • High School Diploma or equivalent (GED)
  • Bilingual or trilingual language skills (Spanish or Portuguese Creole and English)
Experience & Qualifications:
  • Must possess updated Massachusetts CAC (Certified Application Counselor) certification.
  • Minimum of two (2) years' experience working in a direct customer service role.
  • Must understand and be able to explain all the enrollment requirements for all of the government-sponsored programs.
  • Ability to work with persons with disabilities and seniors.
  • Demonstrated oral and written communication/documentation skills.
  • Additional language capabilities in Spanish, Portuguese Creole strongly preferred.
  • Experience working in a fast-paced, diverse environment.
  • Experience and demonstrated proficiency in computer systems and PC-based software.
  • Excellent communication skills.
  • Excellent customer service skills.
  • Excellent organization skills.
  • Ability to work effectively within a team.
  • Ability to take initiative and exercise excellent judgment, make excellent decisions and advanced problem-solving capabilities.

Independent Action:
As described above at "Duties & Responsibilities".

Supervisory Responsibility:
None, but is able to provide input to workflow improvements and staff performance.

Define Access Level to PHI: Level 2: Authorized to access patient demographic data with only minimal reference to treatment or diagnostic information as needed to function. Staff in this category level should confine the use of PHI to the minimum necessary required and should not access or read parts of the medical record not needed to perform assigned duties.

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