The Medical Benefit Specialist (MBS) is responsible for enrolling eligible Illinoisans receiving Ryan White services in the Cook and Collar Counties, into qualified health plans through the Illinois Health Marketplace, insurance companies, Medicaid, Medicare as well as providing assistance with ADAP benefits. The MBS will be required to complete up to 30 hours of training to obtain consumer assistance certification and will be required to recertify on an annual basis at the federal and state level. The MBS will be required to assist clients with submitting payment requests for HIV related out of pocket costs and copays related to their health insurance, as well as educate case managers and clients on how to navigate their insurance benefits. During low insurance enrollment periods, MBS will provide other supportive direct client services as needed.
The salary range for this role is $40,000 to $42,900.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Client Benefits Enrollments
- Coordinate efforts with Ryan White-funded agencies to identify individuals to be enrolled in health insurance programs
- Screen clients for eligibility for Medicaid, Medicare, Health Insurance Marketplace (HIM);
- Assist individuals in understanding HIM plans, managed care options for which they are eligible
- Enroll clients in the appropriate insurance plan they select
- Assist clients with submitting payment requests for HIV related out of pocket costs and copays
- Respond to technical assistance requests in a timely manner using AFC’s internal ticketing system
Client Service Coordination
- Refer clients to appropriate services highlighted in assessments
- Refer clients to more intensive case management services if needed
- Refer clients to other core and supportive services if determined to be necessary
- Complete emergency housing applications for eligible clients
- Travel to meet clients at home, clinical, or community-based setting as needed
- Distribute food vouchers and transportation cards according to eligibility and need and document in the client database
- Complete Medication Assistance Program (MAP) applications
Training Coordination and Resource Assistance
- Arrange and conduct in-reach and outreach activities, including trainings for case managers and clients regarding Marketplace, Medicaid and or CHIP (Continuous Health Insurance Plans) in Cook and Collar Regions
- Function as a resource to case managers and consumers by providing information, assistance and referrals, and taking complaints, or grievances to any applicable office of health insurance consumer assistance or health insurance ombudsman, or any other appropriate state agency or agencies
- Maintain knowledge and expertise by attend trainings and continuing education related to insurance programs as required by AFC including the case management competencies training
- Demonstrate cultural competency when working with clients who may be HIV+, LGBT, homeless, indigent, substance users, mentally ill, non-English speaking, or otherwise marginalized and/or underserved
- Ensure the protection and security of a consumer’s personal, confidential and identifiable information in a professional and responsible manner, according to the standards and requirements of the Health Insurance Portability and Accountability Act (HIPAA);
- Attend all Care Team and AFC-mandated meetings
- Attend and assist with agency-wide events and activities as directed
- Perform other duties as assigned
The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification. It is not necessarily descriptive of any one position in this class. The omission of an essential function does not preclude management from assignment of duties not listed herein if such functions are a logical assignment to the position.
ENTRY REQUIREMENTS (EXPERIENCE AND EDUCATION)
- High School Diploma and 1 plus year’s experience in Case Management and or Public Benefit Screening Experience
- The ability to work non-traditional hours including evenings and weekends.
- Spanish-speaking required
- Bachelor’s degree in the Human Services field (i.e., Psychology, Sociology, Public Health, Social Work).
- A basic understanding of the Affordable Care Act (ACA) and Medicaid services.
- 1 plus year’s experience enrolling individuals into Marketplace plans, Medicaid and/or Medicare.
KNOWLEDGE, SKILLS, AND ABILITIES
- The ability to maintain accurate work records and access these records as necessary.
- Basic knowledge of HIV infection and related chronic diseases.
- The ability to provide excellent service to internal clients and external stakeholders (e.g., vendors).
- The ability to use computer and web-based systems (e.g., PC-based tools, Microsoft applications, Web-based applications) to input, access, modify, or output information or to execute programs or analysis.
- The ability to acquire and apply new knowledge and skills
- The ability to quickly engage others in conversation and build relationships to identify client’s/customer’s needs.
REQUIRED CERTIFICATES, LICENSES, REGISTRATIONS
The physical demands are representative of those found in a general office environment. Tasks involve the ability to exert light physical effort in sedentary to light work, but which may involve some lifting, carrying, pushing and/or pulling of objects and materials of moderate weight (20-25 pounds.)
The work environment is representative of that found in a general office environment. Tasks may involve extended periods of time at a keyboard or workstation.