Benefits and Eligibility Specialist

Competitive salary, exceptional benefits and 34 paid days off to start!

Join an amazing team helping others everyday

JOB SUMMARY:

Serve as an advocate for FCS clients to access health insurance made available through the state Medicaid program or other applicable insurances. Responsible for assisting clients with insurance applications, handling or collecting related documentation, demographics and other relevant information, entering data and/or information collected into EHR, and providing excellent customer service. Responsible for ensuring optimal and timely reimbursement by maintaining accurate client eligibility information and resolving errors before claims are filed.

POSITION SPECIFIC DUTIES & RESPONSIBILITIES:

• Determine client eligibility for Medicaid, Medicare, or other applicable insurance programs.
• Provide information, application assistance, and enrollment assistance in a timely manner, to any clients seeking healthcare coverage.
• Handle questions, issues and provide detailed information on requirements, processes, and policies.
• Ensure applications are completed correctly and that the required supporting materials have been provided.
• Secure necessary documentation to enroll clients in the applicable insurance program(s) (i.e. Authorization & Releases, Income Documentation, Tax Documentation, proof of insurance ineligibility, etc.)
• Generate and complete assigned reports, adhering to established schedules and completion timelines, utilizing the electronic health record system, Report Manager, and PICIS.
• Ensure accuracy of data submitted to guarantors and state agencies, by reviewing, verifying, and updating client information in electronic health record system, including demographics, financial eligibility, services, diagnoses, and authorizations.
• Communicate and collaborate with other agency staff and outside entities, in order to correct errors, resolve issues, and provide assistance to staff both within the department and throughout the agency.

QUALIFICATIONS

EDUCATION:

• Must be a high school graduate or have HS equivalent
• Associate's degree preferred

EXPERIENCE:

• Experience in Medicaid eligibility, enrollment and billing is strongly preferred.
• Customer service experience is preferred

PERFORMANCE COMPETENCIES:

• Client and Public Engagement/Customer Service
• Medicare/Medicaid Knowledge
• Enrollment Documentation
• Essential Behaviors
• Generate and Deliver Reports
• Process and Procedures
• Billing compliance and Accurancy

KNOWLEDGE/SKILLS/ABILITIES:

• Requires a strong understanding of current Medicaid and ODMHSAS rules and regulations in regards to behavioral health, along with knowledge and understanding of HIPAA laws and client privacy.
• Proficient in communication, internal and external customer service, and time management.
• Strong organizational skills and attention to detail is a must.
• Ability to function independently and to maintain an effective working relationship with agency employees.
• Must be efficient, timely, and accurate in all duties and responsibilities.
• Must conduct self professionally, maintain confidentiality, and have strong computer skills, including proficiency in Excel.

CERTIFICATIONS/LICENSES:

• Must possess a valid Driver License and satisfactory driving record and use personal automobile to travel to locations other than primary office. Proof of automobile insurance required.

SAFETY SENSITIVE JOB CLASSIFICATION: This job is classified as a “safety-sensitive” position as defined by the Oklahoma Medical Marijuana and Patient Protection Act. Due to the “safety-sensitive” classification, an employee in this position would be subject to drug and alcohol testing, including random testing. Marijuana is one of the substances included in the drug panel screening. Possession of a medical marijuana license will not excuse you from the testing process or the consequences of testing positive for marijuana per the Family & Children’s Services Drug Free Workplace Policy, including possible revocation of a job offer or dismissal from employment.