Network Benefits Specialist
- Monroe Community Mental Health Authority
- Monroe, MI
- Full Time
- 25 days ago
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Job Description
Summary:
The Network Benefits Specialist position is responsible for completing the initial consumer registration process, determining on an annual and on an as-needed basis the method of consumer reimbursement to the Agency for services provided, ensures consumer insurance information is accurate and up to date in the electronic health record (EHR), and assists with determining whether or not applicants for various programs meet the necessary qualifications. The Network Benefit Specialist provides direct support, if necessary, for the application process as well as follow-up of submission and review of process. This position also ensures consumers maintain their benefits by tracking all Medicaid programs.
Duties and Competencies Assessed by Performance Evaluation(s):
Duties and Competencies
- Interviews new consumers soliciting information from such to complete admission forms and consumer registration process.
- Collects information regarding income, assets, liabilities, level of benefits, insurance coverage, etc. to assess in accordance with standards established by the Board and MDHHS the individual’s ability to pay for services provided by the Board. Processes fee agreement forms, assignment of benefits forms and other forms and information necessary to open consumer accounts consistent with standards established by the Board, MDHHS, state and federal agencies, and private third-party payors.
- Schedules appointments and assesses financial information provided by open consumers to determine their ability to pay for services on an annual basis or as required because of changes in income, insurance, current status, etc., consistent with standards established by the Board, MDHHS, state and federal funding agencies, and private third-party payors.
- Completes computer entry of information related to abilities to pay, financial resources, etc. implementing control functions and reconciling consumer accounts according to Board established policies.
- Processes payments received from individuals and third party payors.
- Conducts annual reviews to ensure insurance information is current and accurate.
- Completes Medicaid applications upon intake for all MCMHA consumers, as necessary.
- Completes assigned shared job functions (Medicaid Deductible/Family Support Subsidy) timely, and submits to Michigan Department of Health and Human Services (MDHHS) as required
- Reviews applications for various aid programs (i.e., Medicaid application, Food Assistance, any MDHHS program) to ensure that applicants are eligible. This entails assisting with the completion of the application process and/or verifying that any application forms have been filled out correctly and checking the information on the forms for accuracy. This may require specialist to follow up with applicants multiple times.
- Verifies insurance information in the MCMHA Electronic Health Record (EHR), adding and updating insurance layers.
- Ensures appointment are scheduled correctly based on physician credentialing.
- Analyzes data to identify trends and areas for improvement in relation to consumer benefits eligibility/Medicaid status report/General Fund. Based on data collection and analysis, specialist will report outcomes that demonstrate improvement in overall percentage of consumers maintaining eligibility.
- Monitors quality of Ability to Pay (ATP) and Financial Determination process in addition to managing Financial Determination verification for provider network.
- Serves as Ability to Pay and Financial Determination specialist, to answer questions from MCMHA staff and MCMHA Provider Network concerning Ability to Pay situations and /or problems concerning ATP/Financial.
- Responsible for documentation and paperwork as well as computerized record keeping. In addition to preparing and maintaining consumer files and any changes in the policies of their organization.
- Assists individuals in applying for Social Security benefits (SSI, SSDI, SSA, Medicare, Medicaid).
- Collects information necessary to reflect Medicaid Deductibles (spenddowns) in the EHR. Additionally, responsible for accumulating service information and communicating with service providers and maintaining a list of all deductible clients monthly to ensure that individuals being served have their spenddowns met and eligibility for Medicaid activated every month by interfacing with MDHHS.
- Acts as an information resource to people who need financial assistance. Provides education and advocacy by advising people on what aid programs may benefit them and then helping them receive that benefit.
Meets with consumers as needed at home, hospital, MCMHA, etc. Some travel is required.
- Assists with Insurance authorizations.
Additional Functions
- Facilitates Ability to Pay/Financial Determination trainings with Providers or new employees as needed.
- Performs audits on charts to maintain quality control in compliance with state, local, and Federal guidelines.
- Assists colleagues or providers with obtaining information necessary to assist a consumer in securing benefits.
- Performs insurance status checks on consumers currently receiving services and requesting new services.
- Maintains productivity standards relative to the requirements of the position.
Attends and participates in meetings, trainings, and conferences as requested.
- Represents MCMHA in a positive, professional manner while interacting with consumers, providers, community members and other MCMHA staff members.
Corporate Compliance Responsibilities:
- Understands, adheres and maintains competency with MDHHS, the Joint Commission and CMHA standards, policies, procedures and requirements of all applicable funding sources.
Interacts appropriately with Managers and peers. Performs required duties with an awareness of impact upon the Authority structure as a whole.
- Works as a Team Player within the entire Authority Structure.
- Keeps abreast of all pertinent federal, state and MCMHA regulations, laws, and policies as they presently exist and as they change or are modified.
The above statements are intended to describe the general nature and level of work being performed by the occupant of the position. The statements are not to be construed as an exhaustive list of all job duties performed.
Education, Training and Licensing Credentials:
- Associate’s degree in accounting, Business Management or Health Information Technology.
In lieu of degree the following may be considered:
- Equivalent of two (2) year degree with accounting courses with two (2) years experience,
- A minimum of three (3) years’ experience in benefit enrollment/eligibility assistance.
- SSI/SSDI Outreach, Access, and Recovery (SOAR Certification) training, upon hire.
- Mental Health First Aid Training, upon hire.
- Experience with various Insurance portals.
- Two years providing eligibility assistance to Medicaid or other state-aid assistance for consumers, preferred; one year required.
Other Competencies and Abilities:
- Demonstrates the ability to work with the diverse populations served by MCMHA, which may include consumers who display challenging behaviors.
- Ability and willingness to work a flexible/variable schedule including availability after scheduled hours.
- Understands principles of medical insurance coverage and range of policies.
- Knowledge of Medicaid eligibility and ability to resolve Medicaid related eligibility issues.
- Knowledge of Social Security entitlements.
- Ability to assist with Medicaid Application/Medicaid Recertification applications.
- Proficiency in typing and proven accuracy in data entry.
- Proficiency in computer applications including Microsoft Office Suite (Word, Excel, Outlook), Electronic Health Record, MI Bridges, MCMHA Intranet and Internet applications.
- Ability to manage multiple files and tasks in an organized and timely manner, with attention to detail.
- Excellent verbal and written communication skills.
- Excellent organizational and time management skills; ability to retrieve information quickly upon request.
- Demonstrates excellent customer service with interpersonal, verbal, and written communication skills along with a non-judgmental and friendly demeanor.
- HIPAA (Health Insurance Portability Accountability Act) and other confidentiality regulations compliance, required.
- Practices confidentiality with every interaction.
- Experienced using office equipment, including but not limited to cellular telephone; desktop VoIP telephone/voicemail; copier/fax program/scanner/printer; computer; and calculator.
Ability to work in a complex, detail-oriented, deadline structured, busy organization. The following physical and mental abilities are required: frequent lifting or carrying up to 15 pounds, must be able to hear, frequent sitting/standing/walking, ability to communicated effectively in person and/or phone, the ability to read, analyze and interpret information, ability to write correspondence and procedures, ability to maintain records, , ability to solve practical problems, ability to define problems, collect data, establish facts and draw valid conclusions, ability to influence others. Demonstrated proficiency in MS Outlook, Word and such other applications if/when required. Ability to be trained and successfully complete other computer training as required. Valid driver’s license, proof of current automobile insurance and driving record determined by the Authority’s insurance carrier to be eligible for coverage if required as part of positions duties.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.