Entitlement Coordinator

SCCMHA JOB VACANCY ANNOUNCEMENT  

CLASSIFICATION: Entitlement Coordinator

PAY GRADE: $26.16 - $30.58 Hourly

POSITION SUMMARY:                     

Under the general supervision of the Entitlements Supervisor, this position is responsible ensuring that SCCMHA consumers obtain the maximum health insurance benefit for which they are eligible. This objective is accomplished through monitoring of enrollment data, assistance with applications and facilitation of communications with relevant agencies such as the Department of Human Services.   Assesses consumer’s Medicaid eligibility based on MPHI and the data exchange gateway (DEG) and determines appropriate waiver linked to the eligibility for identification of the mental health benefits available to the consumer.   This position will be knowledgeable about and actively support culturally competent recovery-based practices; person centered planning as a shared decision-making process with the individual, who defines his/her life goals and is assisted in developing a unique path toward those goals; and a trauma informed culture of safety to aid consumer in the recovery process.     

ESSENTIAL DUTIES AND RESPONSIBLITIES:

1.    Maintains and monitors eligibility in both individual consumer health records and in large databases.  Compares data from different sources to ensure accurate information is used for fund source allocation for services provided. Coordinates and maintains consumer eligibility records between MPHI, the DEG, and the consumer’s SCCMHA financial assessment database in order to assist access center and the finance department to allow for the proper fund source allocation of services received by consumers.

2.    Completes required forms on open clients within the agency and those referred to outside providers.

3.    Processes, enters, retrieves, and verifies consumer Ability to Pay/ Sliding Fee information.

4.    Runs comparison reports between sources of insurance information MPHI, the DEG, and the consumer’s SCCMHA financial assessment database to determine if variances occur in the data.  Researches all variances and makes corrections to the information as needed.  Answers questions regarding eligibility records.

5.    Provides support to DHS outstation workers staff for individual consumer applications ; help eliminate unnecessary delays related to Medicaid determinations by monitoring all pended applications and follows up with DHS when determinations result in a denial of Medicaid eligibility.

6.    Assists with the maintenance of the  spreadsheet to track SCCMHA consumers Medicaid deductible (spend down) information and assist case managers in completing deductible forms to submit to DHS.

7.    Scans all Medicaid information into Sentri consumer file.  

8.    Provides additional financial assessments as necessary.  Maintains recipient eligibility records of all funding sources (Medicaid, Medicare, BCBS, HMO’s, MI-Child, Categorical, etc.) within the system database, as needed.  Verifies Medicaid eligibility through the state’s Michigan-Access software application, and works with Health Home Specialist, and CAI Administrative Assistant to resolve eligibility questions.

9.    Provides training to clinical staff as needed regarding the Medicaid application process and eligibility regulations.

10.    Treats all consumer protected health information (PHI) with strictest confidence and handles this information as required by the SCCMHA adopted HIPAA rules and regulations.

11.    Maintains a professional office setting at all times and organizes workflow in an effective and efficient manner, and completes all other duties as assigned.

12.    Is familiar with and can assist consumers with obtaining Medicare Part D benefits when open enrollment occurs.  

13.    Works with providers in the SCCMHA network to answer questions regarding Medicaid and other entitlement benefits for consumers.  

14.    Reviews policies and procedures as they relate to work with consumer entitlements.  

15.    May be asked to present information about entitlements in various venues.  

16.    Assists with other duties as they pertain to insurance eligibility as well as departmental workflow.  

17.    Adheres to the mission, vision, core values and operating principles of SCCMHA at all times.

INCIDENTAL DUTIES AND RESPONSIBILITES:

1.    Serves all consumers with respect and dignity.

2.    Communicates well with consumers, co-workers, and supervisors.  Meets deadlines and follows through with others as promised in order to provide additional information and/or answer questions.

3.    Demonstrates the ability to provide exceptional customer service to all consumers, staff, and providers of service.

4.    Obtains necessary computer training in order to stay current with system change as needed to complete all tasks related to this position. Works independently to stay informed of changes made with the assigned service area.

5.    Attends meetings, in-service trainings, etc., as required for SCCMHA.

6.    Reacts productively and positively to change and handles other essential tasks as assigned.

 (The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this classification. They are not intended to be construed as an exhaustive list of all duties and responsibilities required of personnel so classified.)

REPORTING RELATIONSHIPS:

Reports to:     Entitlements Supervisor

Supervises:    None

WORKING CONDITIONS/ENVIRONMENT:

Works in a professional office setting in a mental health care environment. May occasionally be exposed to individuals who may become potentially violent.

QUALIFICATIONS:

Education:      An Associates Degree in Accounting, Administration, Business, Healthcare Administration or Human Services field is required. A bachelor’s degree is preferred, and/or additional college education combined with a minimum or 5 years related experience may be substituted.

Experience:    Two (2) years recent experience in a financial/accounts receivable position, preferably within the health care industry and including the interviewing of customers and collection of data from such interviews. Experience should also include working with accounting software with multiple linked financial modules and with spreadsheet software. Possesses direct and extensive experience maintaining consumer insurance records, processing accounts receivable while providing positive customer service.

Licenses and Credentials:    Valid Michigan Driver’s License with good driving record.

Knowledge, Skills, and Abilities:    

1.    Ability to interview and communicate effectively with consumers and occasionally deal with irate individuals.

2.    Ability to diplomatically associate and relate to individuals of all social, economic, and cultural backgrounds.  

3.    Proficiency in Microsoft Office including Word, Excel, and Outlook.

4.    High degree of attention to detail and ability to make math computations quickly and accurately.

5.    Skilled in normal office procedures such as written and verbal correspondence and use of a calculator and other office machines.

6.    Maintaining a current knowledge of regulatory policies, procedures and reporting requirements will be required.

7.    Ability to communicate effectively with others and occasionally deal with irate individuals.

8.    Ability to diplomatically associate and relate to individuals of all social, economic, and cultural backgrounds.

9.    Ability to work independently and organize and prioritize workload

Physical/Mental Requirements:    

1.    Hearing acuity to converse in person and on telephone.

2.    Visual Acuity to read and proofread documents.

3.    Ability to walk, stand, or sit for extended periods of time.

4.    Manual to write and to operate standard office equipment (PC, Keyboard, Copy Machine, Fax Machine, etc.)

5.    Ability to regularly lift and carry files and supplies at least 20 pounds.

6.    Strong interpersonal skills to interact with leadership, employees, consumers and the general public.

7.    Mental capacity to think independently, follow instruction and use judgment.

8.    Ability to plan short and long range and to manage and schedule time.

9.    Ability to handle stress in meeting deadlines and dealing with large numbers of employees and/or consumers.

(Listed qualifications are for guidance in filling this position. Any combination of education and experience that provides the necessary knowledge, skills, and abilities will be considered; however, mandatory licensing or certification requirements cannot be waived. Physical/mental requirements cannot be waived unless specifically indicated.)