Health Benefits Coordinator
Position Summary: The Health Benefit Coordinator (HBC)
Role and Responsibilities
- Completion of applications for state and federal programs (including Health Exchange/Marketplace programs, food stamp and prescription drug assistance programs), reviewing medical records and taking all necessary action to expedite benefit approval.
- Interviewing patients in a community health center or hospital setting and/or home visits to assist the patients in obtaining maximum benefit coverage.
- Making a determination to complete a federal, state, local or pharmaceutical benefit application based upon medical definition of disability as it relates to body systems and to functions of daily living, and information contained in medical records.
- Monitors and fosters ongoing communications with government agencies regarding the status of applications.
- Effectively educates and answers inquiries from patients and family representatives regarding application process.
- Assists callers in resolving account issues by identifying and taking appropriate actions including completing required forms to support application process.
- Reviews inbox for daily work queues, identifies missing evidence and follows through to completion.
- Documents and updates internal database based on daily contact of select members of assigned applicant group and application evidence requirements, i.e. work activity, medical condition, third party, beneficiary, contact and demographic data financial, life and health insurance information, employment and salary verification, medical history and documentation where evidence is required.
- Assists patients with scheduling appointments and reminding of appointments, as needed.
- Complies with ethics, privacy and compliance policies and procedures.
- Assists with completion of prior authorizations alongside the pharmacy team.
OTHER DUTIES MAY BE ASSIGNED TO MEET BUSINESS NEEDS.
Qualifications and Education Requirements
- College degree in related field of Social Services, Human Services, Healthcare or equivalent.
- High School Diploma or its equivalent with five years of experience, in the above mentioned categories may be substituted for the required education.
- Valid Florida Driver’s License and has reliable/accessible transportation.
- Bilingual Spanish/English
- Must complete required CMS Certified Application Counselor (CAC) Training and receive passing score.
- Must maintain Certification as CAC, as a condition of employment.
- Must have knowledge of community resources
- HIV 501
Skills and Abilities
- Must exemplify a professional demeanor.
- Possess empathy with the target population and must be culturally sensitive to all racial/ethnic groups.
- Ability to communicate effectively verbally and in writing in English.
- Ability to establish and maintain effective working relationships with others.
- Must be a self-starter.
- Ability to work independent of constant supervision.
- Ability to prepare and maintain records and reports.
- Must be prepared to report suspected child or elderly abuse as well as suspected fraud to the appropriate authorities.
- Be computer literate.
- Be able to work with clients who may be unable to read, write and are unable to operate a computer.
- Must be able to prioritize work, and be flexible to changes at any moment.
- HIV education and prevention experience, a plus
This job description is not intended to be all-inclusive, and the employee will also perform other reasonable related business duties as assigned by supervisor.
- This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.