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Benefits Eligibility Coordinator

2 months ago

Lanham, United States Ardmore Full time

The Benefits Eligibility Coordinator will provide support between the Finance department, LTSS Coordinator and Services departments and ensures that each person for which we are Representative Payee remains eligible for their Social Security, Medicaid and waiver by developing a tracking system to ensure each entity's annual review process occurs on time and provide auditing oversight of services documentation to ensure supports are accurately reflected in each service area and are in alignment with DDA and waiver requirements. The Services Eligibility Coordinator will provide guidance and support to people supported, their families and/or teams for future planning and resource development.

Ardmore believes that all employees should be committed to supporting the organization's mission of ensuring quality support services are provided and people with intellectual and developmental disabilities are both respected and afforded opportunities to choose and participate in and access community events, activities, and resources.

DUTIES AND RESPONSIBILITES:

  • Develop and maintain a database and tracking system that monitors Medicaid waiver recertification, Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits, Medicare, resources, and assets.
  • Monitor Resident Fund Management System (RFMS) accounts to ensure compliance with Medicaid, SSI, and waiver requirements.
  • Complete SSA reviews- to include annual Representative Payee reports, wage reporting & calculation of IRWE, annual disability reports, account balance documentation & reporting.
  • Facilitate the conversion from SSI to SSDI when a parent or individual retires & application for Medicare insurance coverage.
  • Maintain Medicaid eligibility and redetermination for all individuals served within the Rep Payee program. Serve as a liaison between Ardmore and Division of Waivers Eligibility Services (DEWS).
  • Complete Medicare D prescription program selection in collaboration with the Nurse Manager and Delegating Nurse.
  • Monitor DDA waiver eligibility status for each person supported in all services. Assist with waiver redeterminations, as needed. Communicate with CCS to ensure compliance with waiver program requirements.
  • Monitor spend down needs, assist programs as needed.
  • Assist people supported to establish a Centers for Medicare and Medicaid Services (CMS) and Social Security Administration (SSA) approved, benefits-protected savings account- to include Maryland ABLE, Special Needs trust., Serve as a liaison between ABLE, Trusts & Ardmore.
  • Assist people supported to establish irrevocable pre-needs funeral trusts when needed, and create irrevocable funeral plans that are person-centered and in alignment with their wishes.
  • Provide support and referrals for futures and estate planning. Participate in meetings with people supported, families, guardians, and teams as needed to provide support and guidance.
  • Collaborate with people supported and their teams to explore community-based resources and assist with application and referral processes.
  • Ensure services compliance and eligibility by providing oversight of service documentation.
KNOWLEDGE, SKILLS, AND ABILITIES
  • Thorough knowledge of SSA benefits and requirements to include SSI, SSDI, Wages/Impairment Related Work Expenses (IRWE), Medicare Parts A, B, C, D.
  • Thorough knowledge of SSA Representative Payee program, including guidelines, application process, Payee Reporting procedure.
  • Thorough knowledge of community and waiver-based Medicaid programs.
  • Thorough knowledge of DDA Community Pathways & other waiver programs- to include waiver eligibility process.
  • Futures Planning assistance: ABLE accounts, Special Needs Trusts, estate planning referrals.
  • Preferred: Benefits Planner certification or ability to successfully complete the Benefits Planner certification program.
  • Proficient with technology, software, particularly Microsoft Office.
  • Excellent written, verbal, and non-verbal communication skills.
  • Demonstrated cultural competency and cultural responsiveness.
  • Ability to comply with agency requirements, including, but not limited to, audits, policies and procedures.
EDUCATION AND EXPERIENCE
  • Should have an Associate's degree in Psychology, Social Work or Human Services field. Bachelor's degree preferred.
  • Must have at least three (3) years of experience working with claims and other benefits eligibility.
  • Should have proficient experience with technology and software, particularly in MS Word, Excel, Outlook, etc.
  • Experience with insurance terminology and relevant acronyms
REQUIRED CONDITIONS OF EMPLOYMENT
  • Must be able to lift and/or move up to 50 pounds.
  • Must be able to bend, kneel, push, and pull.
  • Must meet eligibility for employment within the United States. (Provide appropriate I-9 documentation on the first day of employment).
  • Must possess and maintain a good driving record and have access to a reliable vehicle.
  • Must maintain training compliance as required.
  • Must have a clean criminal history.
  • Must be able to pass a drug screening.
  • COVID-19 Considerations: Ardmore Enterprises had a mandatory COVID-19 vaccination policy. All employees are required to be vaccinated, unless a religious/medical exemption is requested.